Referral Guidelines For Dyspepsia In Adults Referral Guidelines For Dyspepsia In Adults Guidelines Checklist Step 1 of 4 25% What is your practiceELR GP FEDERATIONCountesthorpe Health CentreCounty PracticeDr Kilpatrick and PartnersEmpingham Medical CentreEnderby Medical CentreForest House Medical CentreGlenfield SurgeryHazelmere Medical CentreKibworth Health CentreKingsway SurgeryLatham House Medical PracticeLong Clawson Medical PracticeLong Street SurgeryMarket Harborough Medical CentreMarket Overton & Somerby SurgeriesNarborough Health CentreNorthfield Medical CentreOakham Medical PracticeRosemead Drive SurgerySevern SurgerySouth Wigston Health CentreThe Billesdon SurgeryThe Central SurgeryThe Croft Medical CentreThe Husbands Bosworth SurgeryThe Jubilee Medical PracticeThe Limes Medical CentreThe Masharani PracticeThe Uppingham SurgeryThe Wycliffe Medical PracticeTwo Shires Medical PracticeWigston Central SurgeryTestBushloe SurgeyThe following referral guidelines for dyspepsia have been applied since 2012. The referral guidelines are taken from the NICE Clinical Guideline: Dyspepsia- Management of dyspepsia in adults in primary care (2004) and were agreed following consultation with gastroenterologists from UHL and GP representatives from Leicester City PCT and Leicestershire County and Rutland PCT. Patients who have dyspepsia may only be routinely referred for endoscopy if specific clinical criteria are met. The aim of the referral criteria is to only select patients who may have significant pathology for endoscopic investigation and to ensure that all patients have appropriate investigation and management in primary care. You can use this checklist form to confirm you have followed the referral guidelines before referring for endoscopy. What type of referral Immediate (same day) Referral Urgent (two week wait) Referral Routine Referral Is there any evidence of significant acute gastrointestinal bleeding? Yes No You may refer for endoscopyYou may not normally refer for endoscopy. It is recognised that there may be individual clinical circumstances that may warrant an endoscopy but fall outside the guidelines above. In these cases, the GP should provide the relevant additional clinical information in their referral to the gastroenterologist who will then determine whether an endoscopy is clinically necessary. What age is the patient? Under 55 55 or over Is the patient presenting with any of the following alarm symptoms? (you can choose more than one option) Chronic gastrointestinal bleeding Progressive unintentional weight loss Progressive difficulty swallowing Persistent vomiting Documented unexplained iron deficiency anaemia Epigastric mass Abnormal barium meal None of the above You may refer for endoscopyYou may not normally refer for endoscopy. It is recognised that there may be individual clinical circumstances that may warrant an endoscopy but fall outside the guidelines above. In these cases, the GP should provide the relevant additional clinical information in their referral to the gastroenterologist who will then determine whether an endoscopy is clinically necessaryIs the patient presenting with any of the following alarm symptoms? (you can choose more than one option) Chronic gastrointestinal bleeding Progressive unintentional weight loss Progressive difficulty swallowing Persistent vomiting Documented unexplained iron deficiency anaemia Epigastric mass Abnormal barium meal Unexplained new-onset dyspepsia (i.e. no diagnosis has been made for the dyspepsia) Persistent dyspepsia (i.e. symptoms for 4-6 weeks but may be shorter depending on severity) None of the above You may not normally refer for endoscopy. It is recognised that there may be individual clinical circumstances that may warrant an endoscopy but fall outside the guidelines above. In these cases, the GP should provide the relevant additional clinical information in their referral to the gastroenterologist who will then determine whether an endoscopy is clinically necessary.You may refer for endoscopy Please confirm you have undertaken all of the following primary care interventions for uninvestigated dyspepsia Review of medication for possible causes of dyspepsia e.g. NSAID Suspend treatment and treat with PPI therapy at full dose for at least one month (e.g. Lansoprazole 30mg daily) Empirical treatment with both a PPI at full dose for at least one month (e.g. Lansoprazole 30mg daily) H. Pylori testing and treatment If symptoms recur after treatment, PPI therapy used at the lowest dose required to control symptoms (possibly on an as-required basis). Recurrence of symptoms is not an indication for referral for endoscopy. If PPI are ineffective at controlling symptoms, treat with H2RA (e.g. Ranitidine 150mg twice a day) and use the lowest dose required to control symptoms (possibly on an as-required basis). Domperidone 10 mg three times a day can be tried when bloating/early satiety or nausea are prominent symptoms. All of interventions above must be undertaken in primary care prior to making a referral for endoscopy and then documented in the GP referral letter. The referral will be assessed by a consultant gastroenterologist and if the GP letter does not contain this information it will be returned by UHL. It is recognised that there may be individual clinical circumstances that may warrant an endoscopy but fall outside the guidelines above. In these cases, the GP should provide the relevant additional clinical information in their referral to the gastroenterologist who will then determine whether an endoscopy is clinically necessaryDo you need any guidance or help on how to obtain and use H Pylori? No Yes The National Institute for Clinical Excellence recommends carbon-13 urea breath testing as the gold standard for detecting the presence of H. pylori: It is now recommended that eradication of H. Pylori requires a 7-day, twice daily course of quadruple treatment consisting of • Lansoprazole 30mg bd • metronidazole 400 mg bd • amoxicillin 1 g bd • clarithromycin 500 mg bd You may refer for endoscopy It is recognised that there may be individual clinical circumstances that may warrant an endoscopy but fall outside the guidelines above. In these cases, the GP should provide the relevant additional clinical information in their referral to the gastroenterologist who will then determine whether an endoscopy is clinically necessary. Δ
