Patients diagnosed with non-ulcer dyspepsia (NUD) may have symptoms caused by
different aetiologies and should not be routinely treated with PPIs. Should the symptoms
appear to be acid-related, an antacid or the lowest dose of an acid suppressor to control
symptoms should be prescribed. If they do not appear to be acid-related, an alternative
therapeutic strategy should be employed.
1.5 Patients presenting in general practice with mild symptoms of dyspepsia may be treated
on either a “step-up” or a “step-down” basis. Neither group should normally be treated
with PPIs on a long-term basis without a confirmed clinical diagnosis being made.
1.6 In circumstances where it is appropriate to use a PPI and where healing is required, the
optimal dose to achieve this should be prescribed initially. Once healing has been
achieved, or for conditions where it is not required, the lowest dose of the PPI that
provides effective symptom relief should be used.
1.7 The least expensive appropriate PPI should be used.
1.8 The use of PPIs in paragraphs 1.1 to 1.7 refers for each indication only to those PPIs
which have been licensed for that use