Transcript Slide 1
Release date: February 2014 Patient presents with: • Heart burn • Epigastric pain • Bloating • Early satiety Initial consultation and Investigations • Full medical/family/social history • Physical examination Medication Review • NSAIDs • Theophylline • Calcium-channel blockers • Nitrates • Bisphosphonate • Corticosteroids Red Flag Symptoms •Patients of any age with dyspepsia AND with any of the following: o chronic GI bleeding o dysphagia o progressive unintentional weight loss o persistent vomiting o iron deficiency anaemia o epigastric mass •Unexplained worsening of dyspepsia •Patients aged ≥55 years with unexplained & persistent recentonset dyspepsia (after stopping treatment with PPIs) •Abnormal or suspicious findings on barium studies, CT or US scanning Dyspepsia Pathway Diet and Nutrition Advice • Promote healthy eating • Avoidance of ‘trigger’ foods e.g. spicy/fatty foods, caffeine or chocolate • Reduce intake of alcohol / fizzy drinks • Eating smaller meals • Not eating close to bedtime Lifestyle Advice • Weight reduction if necessary • Smoking cessation • Elevation of head-rest to 15 degrees at bedtime • Use of simple antacids OTC / Alginates Physical Activity Advice • Encourage person to identify and make the most of their leisure time and to create relaxation • Assess physical activity levels using general practice physical activity questionnaire No Red Flag Symptoms Present Symptoms resolved /controlled Patient to continue with Lifestyle advice Symptoms do not respond Pathway Key Steps that are based in primary care Steps that are based in acute Decision making point Shared decision making with patient Pharmacological Treatment High Dose PPI therapy Consider: • Omeprazole (20mg, TWICE daily for 1 month) For patients with mild symptoms: • Omeprazole (20mg, ONCE daily for 1 month) Symptoms resolved Stop treatment or step down to lowest level of PPI dose PRN to control symptoms Symptoms do not respond Findings ABNORMAL Secondary Care identification of potential pathology and treated accordingly. Investigative Tests MANDATORY • FBC • U&Es • LFTs including: GAMMA GT • CRP • Ferritin levels OPTIONAL • Abdominal Ultrasound Refer to OGD via CReSS CReSS Dr Tony Brzezicki - Croydon CCG, Dr Mike Mendall, Dr Parth Paskaran, Dr Sanjay Gupta Gastroenterology/Endoscopy, Croydon Health Services NHS Trust OGD Findings NORMAL Discharge to GP Follow-up Reassess for Red Flag Symptoms Red Flag Symptoms present Clinical Authors: Relapse Consider H.Pylori testing and treat as appropriate Red Flag Symptoms present Refer via 2ww Cancer Pathway No Red Flag Symptoms Present If symptoms still persisting but are predominantly bloating and/or other features of IBS consider Tricyclic's