Realistic discharge information
I read the article on dyspepsia guidance with some interest (News, March 19). I am a newly-qualified GP who switched to general practice after three years as a registrar in gastroenterology. I am now salaried to Airedale PCT in West Yorkshire with three of my sessions working as their GPwSI in gastro. One of those sessions will involve developing the dyspepsia service in accordance with the NICE guidelines.
While still an SHO in gastroenterology at Kings Mill Hospital, Sutton in Ashfield, I was involved in a review of 1,000 (not 480) open-access endoscopies.
We found only 17 upper GI cancers, all in elderly patients, who all died soon after diagnosis. The nine patients with oesophageal cancer all had dysphagia, a barndoor alarm symptom that would generate a fast-track referral everytime.
The eight gastric cancers also had alarm syptoms such as weight loss or anaemia. This work has since been published. The holy grail of open-access endoscopy was to find early treatable upper GI cancers and it simply has not done that.
A recent review of 240 fast-track referrals to Airedale General Hospital has shown that even in a group of patients with alarm symptoms only one in 10 had serious pathology (ie gastric or duodenal ulcers) and only one in 20 had an upper GI cancer.
The new guidelines have been distilled out of years of work in this area by the Cochrane group, largely by Professor Paul Moayyedi not just one study of only 480 patients.
You also failed to mention that the NICE guidelines are based on those of the British Society of Gastroenterologists which had been amended in 2004 from the 1996 version which recommended endoscoping patients at 45.
In the last two weeks I have looked at all the open-access referral forms for patients awaiting an endoscopy at Airedale. In the 75 forms I reviewed it is clear that the vast majority of GPs are still referring patients inappropriately (ie young, no alarm symptoms , no trial of PPI and no attempt to establish their HP status).
This comes six months after the NICE guidelines were released.
Dr Mark Follows