• Certain food and drink – such as coffee, tomatoes, alcohol, chocolate and fatty or spicy foods
• Being overweight
• Smoking
• Stress and anxiety

• Non-ulcer dyspepsia (diagnosis made by endoscopy)
• GORD
• Peptic ulcer disease (gastric or duodenal)
• Hiatus hernia
• Pregnancy
• Some medicines, including anti-inflammatory painkillers like  ibuprofen
• Calcium-channel antagonists, antidepressants, and non-steroidal anti-inflammatory drugs)

• Cardiac pain- pain travelling down the arm which is not relieved by antacids accompanied by pale, cold, clammy, breathing difficulties (call 999)
• Medicines causing ADR i.e., NSAIDs, iron, bisphosphonates or corticosteroids
• IBS has similar symptoms accompanied by bloating + abnormal bowel habits

• Gastro-intestinal bleeding (may present as ‘coffee grounds’ in vomit or malaena)
• Dysphagia (difficulty swallowing)
• Progressive unintentional weight loss
• Persistent vomiting
• Iron deficiency anaemia; an epigastric mass; swallowing difficulties, anaemia or suspicious barium meal, all of which may be identified by a GP examination
• Recurrent/ recent changes in medicines in >55

May lead to complications such as oesophageal stricture or Barrett’s oesophagus where the normal cube-shaped cells that line the gullet become replaced by elongated cells

• Foods: fatty food, citrus fruits, onions, coffee
• Smoking and alcohol
• Obesity and genetic factors

• Drugs that relax lower oesophageal sphincters: CCB, theophylline and nitrates
• Calcium-channel antagonists, antidepressants, and non-steroidal anti-inflammatory drugs)

• Gastro-intestinal bleeding (may present as ‘coffee grounds’ in vomit or malaena)
• Dysphagia (difficulty swallowing), urgent referral for complete inability to swallow
• Progressive unintentional weight loss
• Persistent vomiting
• Iron deficiency anaemia; an epigastric mass; swallowing difficulties, anaemia or suspicious barium meal, all of which may be identified by a GP examination