Excerpt

This national guideline provides evidence-based recommendations for the primary care management of dyspepsia symptoms and underlying causes in adults. It was developed for use by the National Health Service in England and Wales. NHS healthcare professionals, patient representatives and researchers developed this guideline, incorporating comments received from referees and from an extensive national stakeholder consultation.

The guideline defines dyspepsia broadly and inclusively, reflecting its presentation and management in the primary care setting. Thus, dyspepsia refers to a spectrum of usually intermittent upper gastrointestinal symptoms, including epigastric pain and heartburn. Annually, 40% of the adult population may suffer from dyspepsia, although only about 2% consult their GP. Currently, prescribed drugs and endoscopies alone annually cost the NHS about £600 million; over-the-counter medication cost patients a further £100 million. The evidence review differentiates between uninvestigated dyspepsia and three main categories arising from investigation: gastro-oesophageal reflux disease, peptic ulcer disease and non-ulcer dyspepsia. Further sub-categories are discussed as the evidence allows.

Contents

• Summary
  • Overview
  • Recommendation overview
  • The community pharmacist
  • Referral guidance for endoscopy
  • Common elements of care
  • Interventions for uninvestigated dyspepsia
  • Reviewing patient care
  • Interventions for gastro-oesophageal reflux disease
  • Interventions for peptic ulcer disease
  • Interventions for non-ulcer dyspepsia
  • Helicobacter pylori testing and eradication
• Methods
  • Scope and Purpose
  • Contributors
  • Acknowledgements
  • Development Methods
  • Declarations
  • References (Methods)
• Evidence
  • Introduction
  • Dyspepsia: definition and prevalence
  • Treatments and procedures for dyspepsia
  • The community pharmacist
  • Common elements of care
  • Referral guidance for endoscopy at presentation
  • Interventions for uninvestigated dyspepsia
  • Reviewing patient care
  • Interventions for gastro-oesophageal reflux disease
  • Interventions for peptic ulcer disease
  • Interventions for non-ulcer dyspepsia
  • Helicobacter pylori testing and eradication
  • Auditing care
  • Future research
  • References (Evidence)
• Appendices
  • Appendix 1. Describing the results of trials
  • Appendix 2. Describing the results of diagnostic tests
  • Appendix 3. Prescription cost analysis for dyspepsia-related drugs
  • Appendix 4. A cost comparison of serology, stool antigen and breath testing for H. pylori
  • Appendix 5. Patients’ and GPs’ views of dyspepsia
  • Appendix 6. Randomised controlled trials of therapies for undiagnosed dyspepsia
  • Appendix 7. Randomised controlled trials of therapies for gastro-oesophageal reflux disease
  • Appendix 8. Economic analyses addressing management of gastro-oesophageal reflux disease (GORD)
  • Appendix 9. Randomised controlled trials of therapies for peptic ulcer
  • Appendix 10. Economic analyses addressing H. pylori eradication in peptic ulcer disease
  • Appendix 11. Randomised controlled trials of therapies for non-ulcer dyspepsia