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Dyspepsia is very common affecting 40% of the population annually, leading to 5% of GP consultations, with 1% going on to OGD.
Please note pre-referral criteria are applicable in this referral and referrals may be returned if this information is not contained within the referral letter.
Routine referrals for dyspepsia now mandate an H. Pylori test.
Routine Referrals
1. Primary Care treatment for dyspepsia has failed (see management section) – please provide details of:
a) treatments tried. Please state if a medication has been declined by the patient or they have a medical contraindication
AND
b) Negative H. Pylori result confirmed in letter (tested after appropriate washout period and performed within a year of the referral date)
2. Persistent H. Pylori infection that has not responded to second line eradication therapy (see management section for details on retesting)
This pathway uses a broad, inclusive definition of dyspepsia of over 4 weeks duration of:
Check for features suggestive of cardiac origin of pain:
Take history of recent medication use, especially any which may be gastric irritant.
Ask about symptoms suggestive of biliary tract disease:
Also consider Ca125 +/- ovarian USS in women over 35 presenting with a feeling of fullness.
Abdominal examination should be performed to check for any masses or gall bladder tenderness.
Patients with symptoms that may require urgent admission, e.g., upper GI bleeding, should be discussed with the on call medical team: Switchboard 01392 411611
Primary care investigations are still appropriate in these patients, but if clinical concern warrants, referrals need not be delayed whilst waiting for test results e.g., H. Pylori.
Referral letters are still expected to state that an H. Pylori has been requested.
Before testing for Helicobacter pylori (H. pylori), a 2-week washout period following PPI use is necessary. Consider offering an H2RA, other than ranitidine, to control symptoms during this period.
H. Pylori is a mandated test prior to referral. Referrals may be returned if this information is not contained within the referral letter.
Lifestyle advice:
Review causative medications:
Medication:
The pharmacological management is outlined on the Formulary sections:
Dyspepsia
Joint formulary - Chapter 1 - Dyspepsia
Proton pump inhibitors
Joint formulary - Chapter 1, section 4.2 Gastro and duodenal ulceration
H Pylori Eradication Therapy
Joint formulary – Chapter 5 – Eradication therapy
Retesting for H pylori:
The majority of patients with functional dyspepsia (64%) will have persistent symptoms despite eradication, therefore routine retesting is not recommended.
Consider if:
If retesting, wait at least 4 weeks, ideally 8 weeks, and use the H. pylori stool antigen test. Offer an H2RA, other than ranitidine, to control symptoms during this period.
Please note pre-referral criteria are applicable in this referral and referrals may be returned if this information is not contained within the referral letter.
Routine Referrals
1. Primary Care treatment for dyspepsia has failed (see management section) – please provide details of:
a) treatments tried. Please state if a medication has been declined by the patient or they have a medical contraindication
AND
b) Negative H. Pylori result confirmed in letter (tested after appropriate washout period and performed within a year of the referral date)
2. Persistent H. Pylori infection that has not responded to second line eradication therapy (see management section for details on retesting)
3. Consider non‑urgent endoscopy to assess for upper GI cancer in people aged 55 or over with:
Urgent Referrals
Urgent endoscopy should be considered in patients of any age with any of the following alarm signs:
Primary care investigations are still appropriate in these patients, but if clinical concern warrants, referrals need not be delayed whilst waiting for test results e.g., H. Pylori.
Referral letters are still expected to state that an H. Pylori has been requested.
2ww Referrals
1. Refer to the upper GI 2ww pathway for patients of any age with:
2. Refer to Colorectal (lower GI) 2ww pathway for patients with unexplained iron deficiency anaemia that meet the criteria outlined
Urgent admissions
Patients with symptoms that may require urgent admission, e.g., upper GI bleeding, should be discussed with the on call medical team: Switchboard 01392 411611
Refer using e-Referral Service
Specialty: GI and Liver (Medicine and Surgery)
Clinic Type: Upper GI inc Dyspepsia
Service: DRSS-Eastern-GI & Liver (Medicine & Surgery)-Devon ICB -15N
Refer using e-Referral Service
Specialty: GI and Liver (Medicine and Surgery)
Clinic Type: Endoscopy
Service: DRSS-Eastern-GI & Liver (Medicine & Surgery)-Devon ICB -15N
This pathway was signed off by the NHS Devon.
Publication date: February 2016
Updated: July 2023