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At the heart of general practice since 1960

'Use family history to target CHD drugs'

GPs no longer need to consider age a red flag for dyspepsia in what has been described as a 'significant change' to clinical practice.

In its final guidance, NICE has ruled that GPs do not

automatically need to refer

patients with persistent dyspepsia for endoscopy if they are over 55.

The guidelines overrule advice from the Scottish Intercollegiate Guidelines Network, issued just over a year ago, and have been criticised for rationing endoscopy.

Dr Ian Allwood, an endoscopist and GP in Stratford-on-Avon, Warwickshire, also expressed concern that the guidelines failed to distinguish between dyspepsia and gastro-oesophageal reflux disease, despite the conditions being treated differently. He said not referring patients over 55 was likely to be 'a significant change for most GPs'.

The new guidance, developed by a group including five GPs, also emphasises the role of patient self-care.

Key NICE recommendations for dyspepsia

•Refer urgently if patients have chronic GI bleeding, unintentional weight loss, progressive dysphagia, persistent vomiting, iron deficiency anaemia, epigastric mass or suspicious barium meal

•In uninvestigated dyspepsia offer one month's empirical proton pump inhibitor treatment or test for H. pylori and then treat if positive

•Eradicate H. pylori in peptic ulcer disease and stop NSAIDs if possible, or offer gastroprotectant or cox-2 inhibitor

•Eradicate H. pylori in non-ulcer dyspepsia

•Offer one or two months' PPI therapy for GORD

•Encourage patient to self-treat with antacids and/or alginates if appropriate

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