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NICE guidance - management of new episode of dyspepsia in primary care

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Management of New Episode of Dyspepsia in Primary Care

Consider referral criteria

  • immediate referral is indicated for significant acute gastrointestinal bleeding. Consider the possibility of cardiac or biliary disease as part of the differential diagnosis (1)
  • NICE urgent cancer referral guidance states (2)
    • Suspected Oesophageal cancer

      • offer urgent direct access upper gastrointestinal endoscopy (to be performed within 2 weeks) to assess for oesophageal cancer n people:
        • with dysphagia or
        • aged 55 and over with weight loss and any of the following:
          • upper abdominal pain
          • reflux
          • dyspepsia

      Suspected Stomach cancer

      • consider a suspected cancer pathway referral (for an appointment within 2 weeks) for people with an upper abdominal mass consistent with stomach cancer
      • offer urgent direct access upper gastrointestinal endoscopy (to be performed within 2 weeks) to assess for stomach cancer in people:
        • with dysphagia or
        • aged 55 and over with weight loss and any of the following:
          • upper abdominal pain
          • reflux
          • dyspepsia

      Non Urgent Referral guidance:

      Suspected stomach cancer/oesophageal cancer:

      • consider non-urgent direct access upper gastrointestinal endoscopy to assess for stomach cancer/oesophageal cancer in people with haematemesis

      • consider non-urgent direct access upper gastrointestinal endoscopy to assess for stomach cancer/oesophageal cancer in people aged 55 or over with:
        • treatment-resistant dyspepsia or

        • upper abdominal pain with low haemoglobin levels or

        • raised platelet count with any of the following:
          • nausea
          • vomiting
          • weight loss
          • reflux
          • dyspepsia
          • upper abdominal pain, or

        • nausea or vomiting with any of the following:
          • weight loss
          • reflux
          • dyspepsia
          • upper abdominal pain

  • routine endoscopic investigation of patients of any age, presenting with dyspepsia and without alarm signs, is not necessary (1)

If referral criteria met then:

  1. review medications for possible causes of dyspepsia, for example, calcium antagonists, nitrates, theophyllines, bisphosphonates, steroids and NSAIDs. Patients undergoing endoscopy should be free from medication with either a proton pump inhibitor (PPI) or an H2 receptor (H2RA) for a minimum of 2 weeks
  2. undertake endoscopy
    1. if upper GI malignancy then refer to specialist
    2. if gastro-oesophageal reflux disease see linked item
    3. if peptic ulcer disease then see linked items gastric ulcer or duodenal ulcer as appropriate
    4. if non-ulcer dyspepsia then see linked item

If referral criteria not met then treat as univestigated dyspepsia (see linked item)

For full details then refer to the full guideline (1).

Reference:

Last edited 03/2019

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