Dyspepsia

Question 1

How do you manage someone with dyspepsia who doesn’t meet the urgent referral criteria?

Answer 1

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
   
   • Test - FP10 for home breath test from pharmacy. £20. They send it off.
   • Then start on first line full dose PPI + amoxicillin 1g + clarithromycin 500mg or metronidazole 400mg.
   • Consider second line eradication therapy if first fails. (see HOT Topics for that)
   • If second line fails, then refer to gastroenterology.

Question 2

What is the urgent (2ww) criteria for referral for suspected oesophageal & stomach cancer?

Answer 2

1. Dysphagia (all patients)
2. Upper abominal mass consistent with stomach cancer (all patients).
3. >= 55 years with weight loss and any of the following:
   
   • Upper abdominal pain
   • Reflux
   • Dyspepsia

Question 3

What is the non-urgent criteria for referral for dyspepsia?

Answer 3

• Haematemesis
• >=55 years with:
  
  • Treatment-resistant dyspepsia.
  • Upper abdominal pain with low Hb levels. (Any aneamia)
  • Raised platelet count with any of the following
    
    • vomiting, weight loss, reflux, dyspepsia, upper abdominal pain.
  • Nausea or vomiting with any of the following:
    
    • weight loss, reflux, dyspepsia, upper abdominal pain.