Table 1.

Recommendations from previous guidelines on various initial management strategies for uninvestigated dyspepsia

Guideline	When to endoscope	When to use “test and treat”	When to use empirical acid suppression therapy
ACG and CAG 2017 (North America)20	First line in people aged ≥60 years; strength of recommendation: conditional; level of evidence: very low. First line in those aged ≥60 years with alarm features; strength of recommendation: conditional; level of evidence: moderate	First line in those aged <60 years; likely to be cost effective even with low rates of infection because of reduction in gastric cancer rates in infected individuals; strength of recommendation: strong; level of evidence: high	First line in those aged <60 years if H pylori negative, or in those who remain symptomatic after eradication therapy; use empirical proton pump inhibitor treatment at standard dose; strength of recommendation: strong; level of evidence: high
NICE 2014 (England and Wales)21	First line in people aged ≥55 years with weight loss and dyspepsia; consider when Helicobacter pylori eradication or empirical acid suppression fails; strength of recommendation: “offer”*; level of evidence: high	First line in people with dyspepsia; if this fails use empirical acid suppression with full dose proton pump inhibitor; strength of recommendation: “offer”*; level of evidence: high	First line in people with dyspepsia; use empirical full dose proton pump inhibitor treatment for four weeks; if this fails use “test and treat”; strength of recommendation: “offer”*; level of evidence: high
Asia-Pacific Working Party 199823	First line in people aged 35-55 years (depending on risk of gastric cancer in region) or alarm features (any age); if H pylori eradication or empirical acid suppression fails consider in younger patients; strength of recommendation: not stated; level of evidence: not reported	Consider if empirical acid suppression fails; in areas with high prevalence of H pylori this strategy is unlikely to be beneficial; strength of recommendation: not stated; level of evidence: not reported	First line for young patients with no alarm features; either proton pump inhibitor or histamine 2 receptor antagonists at standard dose for two to four weeks; strength of recommendation: not stated; level of evidence: not reported

ACG=American College of Gastroenterology; CAG=Canadian Association of Gastroenterology; NICE=National Institute for Health and Care Excellence.

^*“Offer,” for most patients, an intervention will do more good than harm.