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Dyspepsia – Information for GPs

Referral criteria / commissioning position

Patients with symptoms and signs more suggestive of GORD (above the diaphragm i.e. heartburn, sour taste, belching or regurgitation) please refer to the separate GORD referral guidelines.

Refer to secondary care if:

  • conventional primary care management fails to resolve the issue including H.pylori test and treat

Risk factors for cancers: in addition to the red flags above, a lower threshold for referral is suggested in those with a history of Barrett’s oesophagus, pernicious anaemia, intestinal dysplasia, peptic ulcer surgery or a family history of upper GI cancer.

Red flag symptoms

Endoscopy (and hence secondary care referral) is not indicated for dyspepsia without alarm symptoms (red flags) or risk factors for cancer

  • weight loss (unintentional)
  • iron deficiency anaemia
  • vomiting – persistent
  • dysphagia
  • evidence of GI bleeding (blood loss from upper GI tract is a prokinetic agent so may be reflected in change in bowel habit and/or stool colour change
  • epigastric mass
  • patients aged over 55 with unexplained, persistent and recent onset dyspepsia
  1. unexplained: no obvious reason found in the history of dyspepsia
  2. persistent: continuation of symptoms/signs beyond that would normally be associated with self-limiting problems (usually regarded as 4-6 weeks)
  3. recent: new onset and not recurrent symptoms

Investigations prior to referral

  • FBC, U&E, LFTs
  • USS if history suggestive of biliary/pancreatic involvement

Information to include in referral letter

  • Treatments and interventions tried including the results
  • Drug history (prescribed and non-prescribed)
  • Relevant past medical/surgical history
  • Current regular medication
  • BMI
  • Smoking status
  • Alcohol consumption

Patient information leaflets

To view the Dyspepsia Non-Ulcer Patient Information leaflet, please click here

To view the Indigestion Patient Information leaflet, please click here

To view the Helicobacter Pylori and Stomach Pain, please click here

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