Alarm Symptoms Need Urgent EndoscopyDysphagia (difficulty swallowing), persistent vomiting, unintentional weight loss, iron deficiency anaemia, or vomiting blood — urgent 2-week wait referral for upper GI endoscopy.
Common Causes
| Cause | Features | Test | Treatment |
|---|---|---|---|
| Functional dyspepsia | Epigastric discomfort; no structural cause | Clinical; H. pylori test | Lifestyle; PPI; eradication if H. pylori+ |
| H. pylori infection | Often asymptomatic; can cause ulcers | Breath test (gold standard); stool antigen; serology | Eradication triple therapy |
| Peptic ulcer | Epigastric pain; worse or better with food depending on location | Endoscopy | H. pylori eradication; PPI 4–8 weeks |
| GERD | Heartburn; worse lying flat or after meals | Clinical; pH monitoring | Lifestyle; PPI |
| Gastric cancer | Alarm features; older age | Urgent endoscopy | Oncological management |
H. pylori Breath TestThe urea breath test (UBT) is the gold-standard non-invasive test for H. pylori. Stop PPIs for 2 weeks and antibiotics for 4 weeks before testing — they suppress the bacteria and cause false-negatives.
What is H. pylori?
Helicobacter pylori is a bacterium that colonises the stomach mucosa. Present in ~50% of the world's population. It causes 70–90% of duodenal ulcers and 60–70% of gastric ulcers. Eradicating it usually cures peptic ulcer disease.
What is the H. pylori eradication treatment?
Standard triple therapy: PPI + clarithromycin + amoxicillin for 7 days. Quadruple therapy (PPI + bismuth + metronidazole + tetracycline) is used for resistant cases or penicillin allergy. Confirm eradication with breath test 4 weeks after stopping antibiotics.
When should I have an endoscopy for indigestion?
NICE recommends urgent (2-week wait) endoscopy for alarm features in anyone. Routine endoscopy for anyone >55 with new or worsening dyspepsia — to exclude gastric cancer. Under 55 without alarm features: test and treat for H. pylori first.
Does stress cause indigestion?
Yes. Stress increases gastric acid secretion and reduces the mucosal protective barrier. Functional dyspepsia is strongly associated with psychological distress — psychological therapies can significantly improve symptoms.
Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.