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Dyspepsia

There is helpful, patient-friendly information and advice to be found on the GI section of the NHS Lothian Internet pages.  There are also some videos by our very own GI team which patients have been responding very positively to.  Consider sharing the link with patients and/or carers.

https://services.nhslothian.scot/GI/Dyspepsia opens a new window

Definition

Dyspepsia or “indigestion” is very broadly defined as recurrent upper abdominal pain, with or without bloating, nausea and vomiting. Symptoms are often exacerbated by eating and early satiety is a recognised feature.

Referral for endoscopy is seldom necessary in younger patients – cancer is exceptionally rare in patients under 55 with dyspepsia, in the absence of alarm symptoms opens a new window. Some will respond to H. pylori eradication, some will benefit from acid suppression, but the majority will have functional dyspepsia (FD), a disorder of gut-brain interaction (DGBI), similar to IBS.

A test and treat strategy for H pylori should be adopted in the first instance if age <55 years

  • See Primary Care Management for those aged <55 years
  • However, age>55 years is an important determinant of more serious pathology

J.B & I.P 28-08-24

Before considering referral for endoscopy

  • Consider the age of the patient
    • Serious pathology is rare in those <55 years with no alarm symptoms
  • Undertake medication review to look for drugs which make cause or exacerbate symptoms
    • NSAIDs
    • Corticosteroids
    • Opioids including codeine-based analgesia
    • Calcium channel antagonists
    • Nitrates
    • Theophyllines
    • Bisphosphonates
  • Consider other diagnoses
    • Gallstone or biliary disease (especially if severe, episodic pain)
    • Cardiac disease
  • In those who have had a previous endoscopy in last 3 years, but no new alarm symptoms, consider treatment in line with the results of that that previous endoscopy
    • Normal endoscopy & USS- treat as Functional dyspepsia (FD)
    • Previous oesophagitis-treat as GORD
  • A test and treat strategy for H pylori should be adopted in the first instance if age <55 years

Guidelines for referral for Urgent Suspected GI Cancer

Patients with the following:

  • Dysphagia (interference of the swallowing mechanism at any age OR
  • Unexplained Odynophagia (pain on swallowing at any age)
  • Unexplained weight loss, particularly >55 years, combined with one or more of the following features:
    • new or worsening upper abdominal pain or discomfort
    • unexplained iron deficiency anaemia
    • reflux symptoms
    • dyspepsia resistant to treatment
    • vomiting
  • New vomiting persisting for more than two weeks

Refer as USOC via: Sci Gateway – Gastroenterology Medical – GI Upper

Summary of Upper GI Referral Pathways in NHS Lothian

Upper GI Referral Pathways
NHS Lothian Figure 1 NHS Lothian (JB for RH May 2024)