Scribd Logo
Upload

Welcome to Scribd!

  • 110 views

    Dyspepsia Guidelines 2012 From NHS

    Uploaded by

    Citra Yuriana Putri
    This clinical guideline provides recommendations for the treatment of dyspepsia. It recommends testing patients under 55 for H. pylori using a stool antigen test, and referring those over 55 for endoscopy. For H. pylori positive patients, eradication therapy is recommended, while negative patients receive aluminum/magnesium or a low dose PPI. Lansoprazole or omeprazole are recommended as first line treatment for GERD. PPIs should only be prescribed with an appropriate documented indication, as long term use can cause issues. Referral is not needed for those under 55 without alarm symptoms who have not been tested or treated for H. pylori.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Dyspepsia Guidelines 2012 From NHS

    Uploaded by

    Citra Yuriana Putri
    110 views3 pages
    This clinical guideline provides recommendations for the treatment of dyspepsia. It recommends testing patients under 55 for H. pylori using a stool antigen test, and referring those over 55 for endoscopy. For H. pylori positive patients, eradication therapy is recommended, while negative patients receive aluminum/magnesium or a low dose PPI. Lansoprazole or omeprazole are recommended as first line treatment for GERD. PPIs should only be prescribed with an appropriate documented indication, as long term use can cause issues. Referral is not needed for those under 55 without alarm symptoms who have not been tested or treated for H. pylori.

    Original Description:

    Dyspepsia Treatment

    Original Title

    Dyspepsia Guidelines 2012 from NHS

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This clinical guideline provides recommendations for the treatment of dyspepsia. It recommends testing patients under 55 for H. pylori using a stool antigen test, and referring those over 55 for endoscopy. For H. pylori positive patients, eradication therapy is recommended, while negative patients receive aluminum/magnesium or a low dose PPI. Lansoprazole or omeprazole are recommended as first line treatment for GERD. PPIs should only be prescribed with an appropriate documented indication, as long term use can cause issues. Referral is not needed for those under 55 without alarm symptoms who have not been tested or treated for H. pylori.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    110 views3 pages

    Dyspepsia Guidelines 2012 From NHS

    Uploaded by

    Citra Yuriana Putri
    This clinical guideline provides recommendations for the treatment of dyspepsia. It recommends testing patients under 55 for H. pylori using a stool antigen test, and referring those over 55 for endoscopy. For H. pylori positive patients, eradication therapy is recommended, while negative patients receive aluminum/magnesium or a low dose PPI. Lansoprazole or omeprazole are recommended as first line treatment for GERD. PPIs should only be prescribed with an appropriate documented indication, as long term use can cause issues. Referral is not needed for those under 55 without alarm symptoms who have not been tested or treated for H. pylori.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 3

    Clinical guideline

    Dyspepsia treatment
    Recent onset dyspepsia ALARMS Anaemia Loss of weight Anorexia Recurrent symptoms* (dysphagia, odynophagia, persistent continuous vomiting) Mass/Melaena Progressive swallowing problems (dysphagia) No Alarm symptoms

    Under 55 years Test for H. pylori using stool antigen test (preferred option), serology or urea breath test

    Over 55 years Refer for endoscopy

    Positive Hp eradication therapy as per BNF one week course is recommended Persistent or recurrent symptoms refer for endoscopy

    Negative aluminium / magnesium mixture eg Asilone Low dose PPI Lifestyle advice

    Abnormal Appropriate treatment or further referral

    Normal treat as for under 55 years and H. pylori negative

    Urgent referral to G.I. Consultant

    GORD Mild alginate suspension Severe lansoprazole or omeprazole

    Additional Information on PPIs


    PPIs are over-prescribed. Many patients can be adequately treated with an alginate such as Gaviscon Advance Patients should have a documented and appropriate indication for receiving a PPI PPIs suppress gastric acid and cause bacterial overgrowth eg with C difficile Long-term use of PPIs can cause temporary problems of rebound hyperacidity on withdrawal Increased risk of hip fracture with long-term PPI use If NSAID treatment is essential and the patient has an ulcer, prescribe the treatment dose of omeprazole or lansoprazole (cheapest options) If NSAID treatment must continue and the patient has non-ulcer dyspepsia, use a maintenance PPI dose

    When Not to Refer for Endoscopy


    Aged under 55 years and no alarm signs Not yet tested for H. pylori and treated, if necessary Recent normal endoscopy result but persistent symptoms Long established dyspepsia that has not become worse over a period of time NB Most G.I. ulcers are strongly associated with H. pylori infection 30% of endoscopy results are normal 2% diagnose oesophago/gastric cancer Endoscopy is expensive

    Dyspepsia treatment Clinical guideline, V1 Approved by Wirral Drug & Therapeutics Committee: November 2008

    Principal author: Helen Dingle Review date: February 2012 Page 1 of 3

    CHOICE OF PROTON PUMP INHIBITOR (PPI)

    Acid Related Dyspepsia GORD

    Prophylaxis of NSAID GU, DU or gastroduodenal erosions.

    PUD NSAID-induced GU, DU or gastroduodenal erosions.

    Severe erosive GORD

    Barretts oesophagus

    NG / PEG tubes / dysphagia

    Lansoprazole 15mg or omeprazole 20mg capsule daily

    Lansoprazole 15mg or omeprazole 20mg capsule daily

    Lansoprazole 30mg or omeprazole 40mg (2x20mg) capsule daily

    Lansoprazole 30mg capsule twice daily (Consultant Gastroenterologist only)

    Omeprazole 40mg (2x20mg) daily. Dose should not be reduced even if patient is asymptomatic. Ranitidine 150300mg and alginates can be added if necessary

    Lansoprazole (Fastabs) 15mg-30mg daily

    Review at 2 to 4 weeks. Consider stopping/ stepping down to H2 antagonists or alginates.

    Review at 4 weeks, and then 8 weeks where necessary. Consider stopping or stepping down as before.

    Review at 4 weeks, and then 8 weeks and consider maintenance dose of 30mg daily.

    Unable to step down.

    Maintenance dose required.

    Lansoprazole 30mg or omeprazole 40mg (2 x 20mg capsules) daily Review at intervals for step down or discontinuation

    Lansoprazole 15mg or omeprazole 20mg capsule daily Review at intervals for step down or discontinuation

    Appropriate lifestyle modifications should always be encouraged Note: Lansoprazole FasTabs should be placed on the tongue, allowed to disperse and then swallowed, or dispersed in water and then swallowed/administered via a feeding tube.

    Dyspepsia treatment Clinical guideline, V1 Approved by Wirral Drug & Therapeutics Committee: November 2008

    Principal author: Helen Dingle Review date: February 2012 Page 2 of 3

    Additional Information
    Gastric ulcer 70% of gastric ulcers are associated with H. pylori The remainder are associated with NSAIDs Hp positive: Eradication therapy plus ranitidine or PPI for 2 months. Consider long term treatment with PPI in patients with a proven ulcer who continue to take NSAIDs Hp negative: Ranitidine or PPI therapy for 2 months and stop the NSAIDs if possible. Consider long term therapy with a PPI if the NSAID cannot be stopped. Follow up: Repeat endoscopy with biopsies is essential until ulcer is completely healed because of the small risk that cancer is present. Consider surgery if ulcer remains unhealed for six months

    Duodenal ulcer 95% of duodenal ulcers are associated with H. pylori Hp positive: One week triple therapy. No continued PPI required. Hp negative: GI referral is advised if ulcers are not associated with NSAID. Prescribe ranitidine or PPI PPI maintenance is only needed in patients with persistent H.pylori infection or those at risk of serious complications while receiving NSAIDs Follow up: Repeat endoscopy is not needed. A follow up test for H.pylori should be performed one month or longer after eradication therapy if symptoms persist or recur

    NSAIDs and COX-2 Inhibitor therapy If possible, these should be avoided in the following patients -History of an ulcer -Dyspepsia -Those receiving low-dose aspirin -The elderly patients over 70 years on an NSAID are at significant risk of peptic ulcer disease High risk patients should be co-prescribed a PPI if an NSAID is considered essential and should also be tested and treated, if necessary, for H pylori H. pylori If patient tested positive and symptoms persist after triple therapy, re-test at least two weeks after treatment has ended before referring for endoscopy. Serum antigen testing is not appropriate for a re-test (stool antigen test is preferred) and patient must have been off PPIs for at least 2 weeks prior to either test or it is not valid.
    References BSG guidelines NICE guideline CG17 Wirral Hospital NHS Trust Medicines Guide 2007-8

    Dyspepsia treatment Clinical guideline, V1 Approved by Wirral Drug & Therapeutics Committee: November 2008

    Principal author: Helen Dingle Review date: February 2012 Page 3 of 3

    You might also like