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ommunity pharmacist involvement in managing gastro-oesophageal reflux disease (GORD) and dyspepsia leads the advice in the dedicated NICE clinical guideline. Recommendation 1.1 in CG184 states: €Community pharmacists should offer initial and ongoing help for people with symptoms of dyspepsia. This includes advice about lifestyle changes, using over-the-counter medication, help with prescribed drugs and advice about when to consult a GP.€1
   Around 40% of the population will experience symptoms of dyspepsia in any one year. NICE estimates it accounts for between 1.2%-4% of all consultations in primary care in the UK, with 5% of the population consulting their GP. Half of the cases are for functional dyspepsia (dyspepsia of unknown cause or non-ulcer dyspepsia).1,2

   €Dyspepsia describes a range of symptoms arising from the upper gastrointestinal (GI) tract, but it has no universally accepted definition,€ says NICE CG184. €Dyspepsia in unselected people in primary care is defined broadly to include people with recurrent epigastric pain, heartburn or acid regurgitation, with or without bloating, nausea or vomiting.€1

NHS Choices describes indigestion or dyspepsia as €a general term for pain or discomfort felt in the stomach and under the ribs.€ Heartburn is due to acid being regurgitated into the oesophagus causing €a burning pain behind [the] breastbone.€3

There has been a move to distinguish between dyspepsia and GORD, with heartburn and 

acid regurgitation not considered dyspepsia symptoms, but indicative of GORD.  
   Updating the international classification guidelines for GI disorders ('Rome IV') in 2016, gastroenterologists have proposed that, if the diagnosis is made without endoscopy, €functional dyspepsia€ should be characterised by at least one of the following occurring:4,5

€¢ Postprandial fullness;

€¢ Early satiation;

€¢ Epigastric pain; 

   €¢ Epigastric burning.

They also propose two subcategories, which may overlap: 

€¢ Postprandial distress syndrome, characterised by meal-induced dyspeptic symptoms;

€¢ Epigastric pain syndrome that does not occur exclusively postprandially.

   Under Rome IV, gastric reflux ranges from oesophageal hypersensitivity ('functional heartburn') through to excessive acid reflux which can be erosive ('reflux oesophagitis'). In between are 'reflux hypersensitivity' and 'non-erosive reflux disease' (NERD).6