Nice | Dyspepsia and GORD

19th March 2014 by Louise Hudman

Nice | Dyspepsia and GORD

This is an updated guideline from Nice on dyspepsia and GORD. It updates the guideline from 2004 and I must say I found it quite non-specific and a little confusing about certain aspects, e.g. when endoscopy is needed, so this is my interpretation of what it is saying.

Really, the overall advice is the same as before – check for red flags, test or treat (i.e. just treat, or do H Pylori testing, whichever is preferred first), step-down treatment to the lowest possible dose and only refer for endoscopy if people don’t respond to treatment.

I’ll summarise some of the things I found a bit different, or wasn’t maybe doing as this guideline suggests, but otherwise I think that the changes really are minimal.

Assessment

  • Check for GI bleeding
  • Check for red flags
  • Check for aggravants (including medications, which include calcium channel blockers, nitrates, theophylline, bisphosphonates, steroids and NSAIDs).

Who needs referring for endoscopy or other investigation or specialist review?

  • People non-responsive to treatment (they don’t specify how long this should be, though by the time you’ve tried a PPI for the suggested 1/12, tested for H Pylori and then tried an H2RA (H2 receptor antagonist – eg ranitidine) for 1/12, you’re probably 3/12 down the road).
  • People with ‘unexplained symptoms’ (it isn’t clear what they mean by this, but I guess it means if you’re not sure if it is dyspepsia or not).

Join

Join to view the rest of this content, as well as access all the benefits of joining NASGP.

Join

Login

Already a member? Login to view this content.

Login

"I was introduced to the local locum chambers several months ago when I made a career move from partnership. I now combine salaried and locum roles. The chambers provides helpful support, leadership, advice and governance and reduces professional isolation. This combination of support reassures me and helps me provide safe and consistent care to patients within the community . There is a useful, innovative online portal - LocumDeck - which helps me access local work and which has efficient systems for reconciliation of finance including pensions. I would highly recommend joining a locum chambers for any GPs starting out in the locum world ."

Dr Adrian Richardson

Dr Adrian Richardson

See the full list of features within our NASGP membership plans

Membership