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GPs fear for the future of their profession

NICE suffers two body blows as its dyspepsia guidance is condemned and it struggles for credibility over Alzheimer's ­ Emma Wilkinson reports

Patients' lives are being put at risk by NICE guidance on dyspepsia that routinely delays diagnosis of cancer, researchers conclude.

GPs who follow NICE guidance are delaying cancer diagnosis in older patients with new-onset dyspepsia by three months, the study found.

One in 15 patients over the age of 55 referred with new-onset dyspepsia turned out to have cancer, according to the audit of 480 patients.

GPs said the results were 'very significant' and should be rapidly disseminated in order to change referral practice.

NICE guidance released last August recommends that GPs 'test and treat' over-55s with uncomplicated dyspepsia and only refer for endoscopy if symptoms persist.

Study leader Dr Andrew Goddard, consultant gastro-enterologist at Derby City Hospital, said he was 'very uncomfortable' with delaying diagnosis by the three months it would take to follow the test and treat protocol.

'New-onset dyspepsia in over-55s is associated with cancer in a significant percentage of patients and endoscopy must not be delayed by symptomatic treatments,' he said.

Dr Goddard said he had been disseminating his results to GPs to persuade them to ignore NICE guidance.

Professor Michael Griffen, president of the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, said the NICE guidance was 'absolute nonsense'.

He added: 'You will not pick up patients who are potentially curable and that strikes me as fundamentally flawed.

'The guidance is poorly researched and unsubstantiated and is completely at variance with what we believe to be good practice.'

The research, presented at this week's British Society of Gastroenterology conference, found 7 per cent of patients with no alarm symptoms, 7 per cent of those with one alarm symptom and 16 per cent with two had cancer.

Dr David Lyon, PEC chair at Halton PCT and formerly a GP cancer lead, said: 'If GPs knew out of 15 people with new-onset dyspepsia one could have cancer, they would refer straightaway.'

Dr Greg Tanner, a GP in Bridgwater, Somerset, and cancer lead at Somerset Coast PCT, said the results needed to be 'propagated rapidly' to change referral practice.

Researchers audited referrals between 2000 and 2002.

Referral for

endoscopy in

patients with



·Patients of any age with alarm symptoms, eg difficulty swallowing or weight loss

·Patients over the age of 55 with persistent dyspepsia symptoms after test and treat

New study suggests

·Patients of any age with alarm symptoms

·Patients over the age of 55 with any new-onset dyspepsia without delay

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