Virtual Clinic – The patient with persistent dyspepsia

Virtual Clinic – The patient with persistent dyspepsia

Your next patient in clinic is a 38-year old man who has been referred by his GP with treatment-resistant dyspepsia.  

He tells you that for the last 6 months he has been experiencing a burning sensation in the upper abdomen, bloating, and belching which occurs mainly after eating and can last up to an hour.  He finds that Omeprazole 20mg helps with his symptoms, but as soon as he stops taking this, his symptoms return.     

He does not experience acid reflux, vomiting, and has not lost any weight.  

He is a computer programmer, and his job is quite sedentary.  His diet is varied, but he admits that it could be healthier, and he is trying to cut back on his alcohol intake – he currently drinks around 20 units per week (mainly ale).   He does not smoke. His BMI is 26. He does not take any regular or irregular medications.  He has struggled with low mood for some time and has received some psychological therapy for this over the last couple of years.  

His GP has been struggling to manage his symptoms.  Investigations to date include bloods (all normal).  He and his GP wonder if an endoscopy might be helpful.  The patient is worried about his symptoms, and although he has no family history of gastric cancer, he worries about this.  He also wants to know what is causing his symptoms and worries about taking medication long-term.  


Black, C.J., Paine, P.A., Agrawal, A., Aziz, I., Eugenicos, M.P., Houghton, L.A., Hungin, P., Overshott, R., Vasant, D.H., Rudd, S. and Winning, R.C., 2022. British Society of Gastroenterology guidelines on the management of functional dyspepsia. Gut71(9), pp.1697-1723.

NICE 2014 Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management.  Available at


NICE 2018 Oesophago-gastric cancer: assessment and management in adults.  Available at

PHE (Public Health England), 2017 Test and treat for H.Pylori in dyspepsia, available at

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