Background Many patients who present with dyspepsia are prescribed antacid/alginates as their first line and often mainstay therapy. This multicentre study was designed to assess whether early introduction of acid inhibition is an effective strategy in dyspepsia management. Methods Dyspeptic patients (n = 674) were randomized to receive either omeprazole 10 mg o.m. or antacid/alginate liquid 10 mL q.d.s. for 4 weeks in an open, parallel group study. Results Complete relief of the most common symptom at entry, heartburn, was greater in the omeprazole-treated group compared with the antacid/alginate-treated group (64 vs. 30%, respectively, at 4 weeks; P