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.
- 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).