[Summary of the Dutch College of General Practitioners' (NHG) practice guideline 'Gastric symptoms'].

The guideline 'Gastric symptoms' covers the diagnosis and management of adults with dyspepsia in general practice, the prevention of unnecessary proton pump inhibitor use, and gastric protection during treatment with non-steroidal anti-inflammatory drugs (NSAIDs), including low-dose acetylsalicylic acid derivatives. During an initial episode of dyspepsia no distinction is made between reflux and ulcus symptoms because management is the same: start by prescribing an antacid and, if these provide insufficient effect, progress to a H₂-receptor antagonist and subsequently to a proton pump inhibitor (PPI). Testing for Helicobacter pylori should be performed in all patients with persistent or recurrent symptoms, preferably by using the monoclonal stool test. Gastroscopy should be performed with restraint in an H. pylori negative patient < 50 years with persistent or recurrent symptoms but no acute symptoms as there is only a very slight risk of malignancy. - Chronic PPI use is seen in 7% of the population and is associated with infections and osteoporosis. Phasing out of PPI use without good indication seems to be possible in 70% of patients.