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
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
Referral for endoscopy is seldom necessary in younger patients
A test and treat strategy for H pylori can 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
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
- 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 but no new alarm symptoms, consider treatment in line with the results of that that previous endoscopy
- Normal endoscopy & USS- treat as Functional dyspepsia
- Previous oesophagitis-treat as GORD
- A test and treat strategy for H pylori can be adopted in the first instance if age <55 years
- However, age>55 years is an important determinant of more serious pathology
Guidelines for referral for Urgent Suspected GI Cancer
Patients with the following:
- Dysphagia (interference of the swallowing mechanism that occurs within five seconds of the swallowing process) 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
In the absence of alarm symptoms in those aged <55 years
Consider lifestyle measures
- Achieve and maintain healthy weight, avoid food triggers, avoid smoking
Trial of alginates as required
Offer trial of an H2RA (ranitidine 150mg bd)
If no response to simple measures then either
Test and treat Helicobacter pylori
- Check H pylori stool antigen and treat if positive
- Stop PPI for at least 2 weeks prior to test
- See LJF for H pylori treatment regimes
or
Treat with full dose PPI (omeprazole 20mg od or equivalent) for 4 weeks
- If symptoms recur offer ongoing PPI therapy but step down treatment to lowest effective dose
- Discuss use of “as required” treatment to encourage self- management of symptoms
- Offer annual review to assess symptom control and reduce or withdraw treatment if possible
Further information
- Management of those with normal investigations (Functional dyspepsia)
