2ww gastroscopy for: Dysphagia OR New onset dypepsia <6 months AND Age >55 AND • Unexplained weight loss • Anaemia DYSPEPSIA Upper abdominal pain or discomfort, heartburn, gastric reflux, nausea or vomiting Lifestyle modification: • Adapt diet • Stop smoking • Review medications • Aim for BMI 20-25 • Stress management Consider secondary care referral if: Vomiting Heartburn and acid brash (food coming back up) Possible gastroparesis (DM, scleroderma) May benefit from pH manometry etc. Check H. Pylori Triple therapy and review response Trial of PPI: eg. omeprazole 20mg BD for four weeks – then review Titrate to minimum dose which controls symptoms (PRN use if possible). If breakthrough symptoms take extra PPI After 5 years consider one- off community endoscopy Direct Access Endoscopy FUNCTIONAL DYSPEPSIA See attached information leaflet (for GP and patient ) +ve -ve Response to PPI No response to PPI No response No further action required Respons e Normal endoscopy Pathology Treat as appropriate Possible biliary cause? Consider USS abdomen Possible cardiac cause? Consider cardiology Ix Any recent bloods? Consider FBC, U&E, LFT, TTG, ferritin
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months AND Age >55
DYSPEPSIA Upper abdominal pain or discomfort, heartburn, gastric reflux, nausea or vomiting
Lifestyle modification:
Consider secondary care referral if:
Vomiting Heartburn and acid brash (food coming back up)
Possible gastroparesis (DM, scleroderma) May benefit from pH manometry etc.
Check H. Pylori Triple therapy and review response
Trial of PPI: eg. omeprazole 20mg BD
for four weeks – then review
Titrate to minimum dose
which controls symptoms (PRN use if possible). If breakthrough symptoms
take extra PPI
off community endoscopy
Direct Access Endoscopy
DYSPEPSIA Upper abdominal pain or discomfort, heartburn, gastric reflux, nausea or vomiting
Lifestyle modification:
Consider secondary care referral if:
Vomiting Heartburn and acid brash (food coming back up)
Possible gastroparesis (DM, scleroderma) May benefit from pH manometry etc.
Check H. Pylori Triple therapy and review response
Trial of PPI: eg. omeprazole 20mg BD
for four weeks – then review
Titrate to minimum dose
which controls symptoms (PRN use if possible). If breakthrough symptoms
take extra PPI
off community endoscopy
Direct Access Endoscopy
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