Guidelines

Managing Patients on Continuing Treatment For Dyspepsia and Associated Symptoms: Practical Guidelines. Guidelines developed for use in primary care in the UK that give practical, clinical and financial help in the management of acid-related disorders. Click on the title to open and print the guidelines.

National Institute for Clinical Excellence (NICE) (www.nice.org.uk)

NICE is part of the National Health Service (NHS) in the UK, and produces guidance for both the NHS and patients on medicines, medical equipment and clinical procedures. They have 2 guidelines relating to dyspepsia:

National Institute for Clinical Excellence. Dyspepsia: Managing dyspepsia in adults in primary care. Centre for Health Services Research Report No 112. University of Newcastle upon Tyne, 2004. [ISBN: 0-9540161-7-3]
(Also available at: www.nice.org.uk/pdf/CG017fullguideline.pdf)

  • A key recommendation in these guidelines is for GPs to encourage patients to use antireflux treatment when they need it, and to become more involved in choosing the most appropriate medication for their particular dyspepsia symptoms.
  • The guidelines emphasise reducing the number of routine endoscopies undertaken, and managing uninvestigated dyspepsia. They recommend that patients should be managed symptomatically by their GP.
  • The guidelines also recognise the role of OTC treatments for dyspepsia, as well as PRN prescribing.

National Institute for Clinical Excellence. Guidance on the Use of Proton Pump Inhibitors in the Treatment of Dyspepsia. London: NICE, 2000. (Technology Appraisal Guidance No 7.) [ISBN 1-84257-018-8]
(Also available at: www.nice.org.uk/pdf/proton.pdf)

  • This appraisal focuses on the use of PPIs in the treatment on dyspepsia (encompassing heartburn and indigestion, and including GORD).
  • The guidance recommends that practitioners review all patients receiving PPIs with the aim of reducing or stopping the medicine where appropriate, following the ‘step-down’ approach. For newly presenting patients, the ‘step-up’ approach is recommended. For example, for patients with mild GORD lifestyle modifications and/or alginates or antacids can be recommended initially, stepping up to PPIs if this initial approach does not adequately control the symptoms.

British Society of Gastroenterology (BSG) (www.bsg.org.uk)

British Society of Gastroenterology. Dyspepsia Management Guidelines. London: BSG, 2002.
(Also available at: www.bsg.org.uk/pdf_word_docs/dyspepsia.doc)

  • These are evidence-based guidance on the diagnosis and management of dyspepsia.
  • The guidelines were last revised in April 2002, and the main revisions were:
    • To increase the age at which endoscopy is recommended for new dyspepsia from 45 to 55 years
    • To recommend that patients under 55 years with uncomplicated dyspepsia on the basis of a positive H. pylori test are treated, rather than having an endoscopic examination
    • To recommend that the ‘gold standard’ test for identification of H. Pylori and for confirmation of eradication is the 13C urea breath test
    • To recommend that the guidance issued by NICE on the use PPIs in the treatment of dyspepsia should be followed.

American Gastroentorological Association (AGA) (www.gastro.org)

Improving the Management of GERD: evidence-based therapeutic strategies (2002)
(Also available at: www.gastro.org/edu/GERDmonograph.pdf)

  • This CME accredited GERD monograph seeks to develop consensus recommendations for therapeutic approaches to GERD management by bringing together a panel of 8 experts in the field of gastroenterology under the auspices of the AGA. The panel critically examined the current evidence in support of medical and surgical treatment of GERD.
  • This educational monograph summarizes those findings and sets recommendations for the diagnosis and treatment of GERD and is aimed at gastroenterologists, primary care physicians, and pharmacists who provide clinical advice and care for patients with acid reflux or GERD.
bottom frame image