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Guidance clarifies GPs' referral options over dyspepsia

The National Institute for Clinical Excellence has told GPs to cut urgent endoscopy referrals for dyspepsia patients.

The second draft of NICE's primary care dyspepsia guidelines, released last week, said patients under the age of 55 without alarm signs should not have endoscopy but recommended specialist referral or endoscopy within two weeks in cases of dyspepsia with warning signs such as chronic gastrointestinal bleeding or an epigastric mass.

The guidelines also said dyspeptic patients of any age should have a same-day specialist referral for dyspepsia with acute gastrointestinal bleeding.

Dr Richard Stevens, chair of the Primary Care Gastroenterology Society, welcomed the new draft. He said: 'This guideline recognises that dyspepsia is a benign disease and that we should stop scoping everybody.'

However, the advice on managing patients diagnosed with dyspepsia was unclear and contradicted advice from the British Society of Gastroenterology, he said.

This left it up to GPs to decide whether to prescribe acid-suppressing proton-pump inhibitors or to 'test and treat' for Helicobacter pylori.

The NICE guidance said there was 'insufficient evidence' to guide whether a course of PPIs or a 'test and treat' approach should be offered first.

Dr Stevens pointed out this was left open because the guidelines had failed to distinguish reflux symptoms from dyspepsia, saying that although the symptoms often co-existed, one often predominated. 'If there are dyspepsia symptoms you would test and treat, but if it's reflux then you would use acid suppressants,' he said.

NICE had produced quality markers that should be recognised under the new GMS contract, he added.

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