Dyspepsia Flashcards
Dyspepsia
2015 NICE guidelines ‘Suspected cancer: recognition and referral’ further updated the advice on who needs urgent referral for an endoscopy (i.e. within 2 weeks).
Urgent
All patients who’ve got dysphagia
All patients who’ve got an upper abdominal mass consistent with stomach cancer
Patients aged >= 55 years who’ve got weight loss, AND any of the following:
upper abdominal pain
reflux
dyspepsia
Non-urgent
Patients with haematemesis
Patients aged >= 55 years who’ve got:
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
nausea or vomiting with any of the following: weight loss, reflux, dyspepsia, upper abdominal pain
Managing patients who do not meet referral criteria (‘undiagnosed dyspepsia’)
This can be summarised at a step-wise approach
1. Review medications for possible causes of dyspepsia
2. Lifestyle advice
3. Trial of full-dose proton pump inhibitor for one month OR a ‘test and treat’ approach for H. pylori
if symptoms persist after either of the above approaches then the alternative approach should be tried
Testing for H. pylori infection
initial diagnosis: NICE recommend using a carbon-13 urea breath test or a stool antigen test, or laboratory-based serology ‘where its performance has been locally validated’
test of cure:
there is no need to check for H. pylori eradication if symptoms have resolved following test and treat
however, if repeat testing is required then a carbon-13 urea breath test should be used
If a patient is taking a proton pump inhibitor or H2 receptor blocker then it should be stopped at least 2 weeks prior to the endoscopy as it could mask serious underlying pathology such as gastric cancer
Testing for Helicobacter pylori is an important investigation for those presenting with dyspepsia. Usually testing for Helicobacter pylori is done if symptoms persist despite treatment with a proton pump inhibitor. Usually a 2 week washout period is recommended after stopping the proton pump inhibitor prior to testing for Helicobacter pylori .
