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Dyspepsia in children - DRAFT

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Overview

Dyspepsia in children is a symptom that usually does not indicate concerning underlying disease. It may be associated with bloating, nausea, early satiety, or belching. It is often functional but may be associated with other gastrointestinal disorders.

Assessment in primary care should include a thorough history and examination to help exclude any red flag symptoms or predisposing factors.

Please also see the following pages:

Reflux Disease - links to guidelines on Gastro-oesophageal reflux in infancy
Common Urgent Care Conditions - includes advice on management of acute abdominal pain and diarrhoea/vomiting.

Red Flags

Consider same day referral to ED if any of the following are present:

Abdominal mass, Hepatomegaly, Splenomegaly - Same Day ED assessment unless well child with alternative explanation for findings.

Consider Children & Young People – USC (2WW) referral if there are other concerning symptoms such as:

Unexplained weight loss
Appetite loss
Unexplained fatigue/malaise/lethargy
Persistent nausea/vomiting
Profuse night sweats
Unexplained pruritus
Unexplained persistent infection
Unexplained shortness of breath
Pallor or other signs of anaemia
Lymphadenopathy with red flag features
Unexplained persistent vague symptoms (3≥ consultations)

Investigations in primary care

If there are no red flags then further investigation in primary care is rarely indicated. However if other gastrointestinal disorders are suspected then consider the following:

FBC – anaemia or infection
TTG (Coeliac screening) - see Coeliac disease (children)
Faecal calprotectin (consider) - see Chronic Abdominal Pain and IBD for further advice.

Please note

Helicobacter pylori testing in children is not recommended - see section below.
Abdominal USS requests for children with dyspepsia or abdominal pain are not advised from primary care and may be returned.

Helicobacter Pylori

Local paediatricians advise that testing for H. pylori is not useful in children with dyspepsia. The presence or absence of H. pylori is unlikely to correlate with GI symptoms in the vast majority of children.

Where H. pylori populates the stomach is different in children to adults, and for this reason is not associated with GI malignancy.

If symptoms are significant enough to suggest gastritis, the child requires advice and guidance/referral to general paediatrics and consideration of the need for endoscopy.

If gastritis is found at endoscopy, H. pylori testing will be arranged.

Functional Dyspepsia

Functional dyspepsia is the most common cause of symptoms in children and can often be diagnosed following history and examination. Children who do not have and red flag symptoms are very unlikely to have organic disease so management should be focused around reassurance and lifestyle advice as below:

Reassure: Often benign and self-limiting

Lifestyle advice:

Small, regular meals
Avoid trigger foods (fatty, spicy, caffeine, fizzy drinks)
Limit NSAID use
Encourage good sleep hygiene

Psychological support: Address stress or anxiety

Trial of acid suppression:

Omeprazole for 4–8 weeks
Avoid long-term use without a diagnosis

Referral

Consider paediatric advice and guidance (general paeds) or referral to general paediatrics via eRS if:

Alarm features or abnormal investigations (although consider USC/2WW referral - see Red Flag section above)
Symptoms refractory to 8-week acid suppression
Diagnostic uncertainty
Suspected IBD, coeliac disease, or other chronic conditions

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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