Patients with dyspesia in whom an OGD is appropriate

Review medications for possible causes of dyspepsia (for example, calcium antagonists, nitrates, theophyllines, bisphosphonates, corticosteroids and non-steroidal antiinflammatory drugs [NSAIDs]). In patients requiring referral, suspend NSAID use.

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

Reference:

• NICE (2014). Dyspepsia - management of dyspepsia in adults in primary care.
• NICE (June 2015). Referral Guidelines for Suspected Cancer