Download Dyspepsia not requiring investigation

Dyspepsia not requiring investigation
1
Dyspepsia not requiring investigation
Quick info:
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Routine endoscopy is not indicated in patients under age 55 years if
there are none of the following alarm symptoms:
- chronic gastrointestinal bleeding
- progressive weight loss (unintentional)
- progressive difficulty swallowing
- persistent vomiting
- iron deficiency anaemia
- mass in epigastrium
- suspicious barium meal
- any patient over age 55 years with unexplained and persistent recent
onset dyspepsia
 Excludes patients with predominant reflux symptoms
 Some guidelines advise endoscopy for patients over 55 years of age
who present with new onset dyspepsia without alarm symptoms but the
evidence for this recommendation is weak
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Lifestyle advice, medication review and symptomatic treatment
Quick info:

Advise patient to avoid triggers that may be associated with dyspepsia
such as:
smoking
alcohol
coffee
chocolates
fatty foods
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Advise patient on weight reduction being overweight may cause
dyspepsia
Raising the head of the bed and not eating close to bedtime may
reduce dyspepsia symptoms in some people
Consider antacid and/or alginate therapy for immediate symptom relief
Review medications that may cause dyspepsia
Consider whether the following may be reduced or stopped:
NSAIDs
Calcium antagonists
Nitrates
Theophyllines
Bisphoshonates
Steroids
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Review
Quick info:
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Review upper gastrointestinal tract symptoms:
upper abdominal pain or discomfort
heartburn
acid reflux
nausea
vomiting
reconsider differential diagnosis
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Advise continuing self care
Quick info:
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Advise patient to avoid triggers that may be associated with dyspepsia
such as:
smoking
alcohol
coffee
chocolates
fatty foods
advise patient on weight reduction, as being overweight may cause
dyspepsia
raising the head of the bed and not eating close to bedtime may reduce
dyspepsia symptoms in some people
Consider antacid and/or alginate therapy for immediate symptom relief
Review medications that may cause dyspepsia
Consider whether the following may be reduced or stopped:
NSAIDs
Calcium antagonists
Nitrates
Theophyllines
Bisphoshonates
Steroids
Advise patient to consult again if symptoms return despite these
measures
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Helicobacter pylori test
Quick info:
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Helicobacter pylori is associated with peptic ulcer disease and non
ulcer dyspepsia
H. pylori can be detected using:
Stool antigen test : now available at NWLHT
Carbon-13 urea breath test
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If proton pump inhibitor (PPI) used, perform H. pylori test at least
2 weeks after finishing treatment
 Serology:
a positive result cannot differentiate between active or past infection
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Give eradication therapy for one week
Quick info:
Eradication regimens:
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Proton pump inhibitor (PPI) plus amoxicillin and clarithromycin
PPI plus metronidazole and clarithromycin
Consider proton pump inhibitor (PPI)
Quick info:
The benefit from proton pump inhibitor (PPI) in patients with functional
dyspepsia is small – only 1 in 10 show a therapeutic gain over placebo
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Review at 6 weeks
Quick info:
Review upper gastrointestinal tract symptoms:
upper abdominal pain or discomfort
heartburn
acid reflux
Nausea
Vomiting
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If symptoms persist, manage as functional dyspepsia
Quick info:
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Majority of patients will have functional dyspepsia often associated with
irritable bowel symptoms and/or psychosocial factors
they do not usually respond to medication aimed at the gastrointestinal
track
for most patients, management is based on explanation and
reassurance
Advise continuing self care
Quick info:







Advise patient to avoid triggers that may be associated with
dyspepsia such as:
smoking
alcohol
coffee
chocolates
fatty foods
advise patient on weight reduction, as being overweight may cause
dyspepsia
raising the head of the bed and not eating close to bedtime may reduce
dyspepsia symptoms in some people
Consider antacid and/or alginate therapy for immediate symptom relief
Review medications that may cause dyspepsia
Consider whether the following may be reduced or stopped:
NSAIDs
Calcium antagonists
Nitrates
Theophyllines
Bisphoshonates
Steroids
Advise patient to consult again if symptoms return despite these
measures
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Review management plan
Quick info:
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Re-treat
Refer for specialist advice
Refer for endoscopy
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If symptoms persist, manage as functional dyspepsia
Quick info:


Majority of patients will have functional dyspepsia often associated
with irritably bowel symptoms and/or psychosocial factors
they do not usually respond to medication aimed at the
gastrointestinal tract
for most patients, management is based on explanation and
reassurance