REMEDY : BNSSG referral pathways

Dyspepsia and Reflux Referral Pathway

Checked: 14-02-2017 by Rob.Adams Next Review: 06-06-2018

Principles of Management

Clinical Knowledge Summaries has information on assessment and management of:

Dyspepsia and Reflux - unidentified cause- covering management of patients with uninvestigated dyspepsia in primary care and when to refer.

Dyspepsia and Reflux - proven GORD - covering management of adults with endoscopically  determined GORD

Prime Endoscopy have also developed guidelines for the management of Dyspepsia and Gastro-oesophageal reflux disease (word doc) using BSG and NICE guidelines.

 

Referral

If referral for endoscopy is indicated please see link to Endoscopy guidelines

A community gastroenterology service run by PRIME is also available via e-referral. New patients are booked at 30 minute intervals. The emphasis is on a one stop referral, either discharging to the GP with a management plan or proceeding to endoscopy if clinically indicated.

For information please refer to the PRIME service Guide

Functional Dyspepsia

Functional dyspepsia (also known as non-ulcer dyspepsia) refers to people with dyspepsia symptoms and normal findings on endoscopy. Functional dyspepsia is the most common diagnosis arising from endoscopy for dyspepsia symptoms.

Management includes reassurance, lifestyle measures, management of aggravating factors, H Pylori eradication and trial of PPI. A low dose of tricyclic anti-depressants is also sometimes worth considering.

Further advice can be obtained in Clinical Knowledge Summaries - Dyspepsia - proven functional.

For patients who have refractory symptoms, further advice can be obtained from the Gastroenterology Advice and Guidance service or a referral to the Community Gastroenterology Clinic (PRIME) via e-referral (see above)

Red Flags

Red flags include:

  • Upper abdominal mass

  • Dysphagia

  • Age 55 or over with weight loss and one or more of the following: upper abdominal pain, reflux, dyspepsia.

Please see 2WW guidelines for further information