“I’ve had burning indigestion and stomach pain since starting my new tablets — do I just need something for the acid?”

New DYSPEPSIA temporally linked to a medication change is often IATROGENIC (drug-induced), the commonest culprit being an NSAID, with others including aspirin/antiplatelets, oral bisphosphonates, corticosteroids, SSRIs, iron, calcium-channel blockers, nitrates and theophylline — so take a history linking onset to the drug. Critically, screen ALARM features that change management: GI bleeding (haematemesis/melaena, faintness or collapse) on an NSAID needs same-day hospital assessment as a possible bleeding ulcer (NICE CG141), not a referral pathway; iron-deficiency anaemia, persistent vomiting or an epigastric mass need clinical assessment; and, per NICE NG12 upper-GI, dysphagia at any age or age ≥55 with weight loss plus upper abdominal pain, reflux or dyspepsia — which warrants a suspected cancer pathway referral for oesophageal or stomach cancer (this replaced urgent direct-access endoscopy in 2025); age ≥55 with treatment-resistant dyspepsia warrants consideration of non-urgent direct-access endoscopy. The right action is to REVIEW the medication rather than reflexively add acid suppression: where possible stop/switch the culprit (e.g. stop the oral NSAID and use a topical NSAID with exercise and weight management for knee osteoarthritis — NICE NG226 advises against routinely offering paracetamol; lowest effective dose for the shortest time; reconsider the indication), because masking drug-induced symptoms with a PPI while continuing an ulcerogenic NSAID is poor practice. If an NSAID/antiplatelet must continue, co-prescribe a PPI for GASTROPROTECTION, especially with risk factors (age, previous ulcer/bleed, anticoagulants/steroids/SSRIs, H. pylori), and consider H. pylori test-and-treat (after 2 weeks off a PPI), with lifestyle advice (weight, alcohol, trigger foods, smoking). Manage per NICE CG184 (dyspepsia and GORD in adults), review the response, escalate/endoscope if dyspepsia persists despite stopping the drug or if red flags emerge, and avoid long-term unreviewed PPIs. The skill is recognising the drug cause, reviewing/rationalising medication rather than just adding a PPI, red-flag/NICE NG12 screening, and gastroprotection. NICE NG12 upper-GI applies where red-flag/age criteria are present.