NHS Dudley Health Economy Medicines Formulary
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1 Gastro-intestinal system

General Guidance

  • Dyspepsia, typically as heartburn or food-related discomfort (indigestion), occurs with gastro-oesophageal reflux disease, gastric and duodenal ulceration and gastric cancer. Most commonly it is of uncertain origin. Helicobacter pylori infection may be present in some patients with non-ulcer dyspepsia but there is little evidence that its eradication provides symptomatic relief. For NICE guidance summary click here. For full NICE guidance click here.
  • There is little comparative data to indicating whether a step-up or step-down approach should be adopted to the management of dyspepsia, a step-up approach would seem reasonable in most cases especially those with mild symptoms. Use of life-style measures may also be helpful in such circumstances.
  • All patients presenting with ALARM symptoms should be referred for an urgent endoscopy.
  • All patients over 55 years of age presenting with new symptoms of dyspepsia should be referred for endoscopy, please see upper GI cancer referral proforma.
  • Patients over 45 years of age presenting with lower gastro-intestinal tract symptoms, including rectal bleeding, change in bowel habit or other ALARM symptoms should be referred for rapid open access fibresigmoidoscopy.
  • Patients over 55 years of age should not receive H pylori eradication therapy prior to endoscopy.
  • Patients should not have proton pump inhibitor or histamine H2-receptor antagonist therapy commenced empirically when being referred for endoscopic assessment as this has been shown to mask malignancy in some cases. 
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