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NICE guidance - management of new episode of dyspepsia in primary care

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Management of New Episode of Dyspepsia in Primary Care

Consider referral criteria

  • immediate referral is indicated for significant acute gastrointestinal bleeding. Consider the possibility of cardiac or biliary disease as part of the differential diagnosis (1)
  • NICE urgent cancer referral guidance states (2)
    • Suspected Oesophageal cancer Suspected Stomach cancer Non Urgent Referral guidance: Suspected stomach cancer/oesophageal cancer:
      • offer urgent direct access upper gastrointestinal endoscopy (to be performed within 2 weeks) to assess for oesophageal cancer n people:
        • with dysphagia or
        • aged 55 and over with weight loss and any of the following:
          • upper abdominal pain
          • reflux
          • dyspepsia
      • consider a suspected cancer pathway referral (for an appointment within 2 weeks) for people with an upper abdominal mass consistent with stomach cancer
      • offer urgent direct access upper gastrointestinal endoscopy (to be performed within 2 weeks) to assess for stomach cancer in people:
        • with dysphagia or
        • aged 55 and over with weight loss and any of the following:
          • upper abdominal pain
          • reflux
          • dyspepsia
      • consider non-urgent direct access upper gastrointestinal endoscopy to assess for stomach cancer/oesophageal cancer in people with haematemesis

      • consider non-urgent direct access upper gastrointestinal endoscopy to assess for stomach cancer/oesophageal cancer in people aged 55 or over with:
        • treatment-resistant dyspepsia or

        • upper abdominal pain with low haemoglobin levels or

        • raised platelet count with any of the following:
          • nausea
          • vomiting
          • weight loss
          • reflux
          • dyspepsia
          • upper abdominal pain, or

        • nausea or vomiting with any of the following:
          • weight loss
          • reflux
          • dyspepsia
          • upper abdominal pain

  • routine endoscopic investigation of patients of any age, presenting with dyspepsia and without alarm signs, is not necessary (1)

If referral criteria met then:

  1. review medications for possible causes of dyspepsia, for example, calcium antagonists, nitrates, theophyllines, bisphosphonates, steroids and NSAIDs. Patients undergoing endoscopy should be free from medication with either a proton pump inhibitor (PPI) or an H2 receptor (H2RA) for a minimum of 2 weeks
  2. undertake endoscopy
    1. if upper GI malignancy then refer to specialist
    2. if gastro-oesophageal reflux disease see linked item
    3. if peptic ulcer disease then see linked items gastric ulcer or duodenal ulcer as appropriate
    4. if non-ulcer dyspepsia then see linked item

If referral criteria not met then treat as univestigated dyspepsia (see linked item)

For full details then refer to the full guideline (1).

Reference:


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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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