nice guidelines on dyspepsia

Do not routinely investigate or treat for gastro-oesophageal reflux if an infant or child without overt regurgitation presents with only 1 of the following: Consider referring infants and children with persistent back arching or features of Sandifer's syndrome (episodic torticollis with neck extension and rotation) for specialist assessment. It is a common physiological event that can happen at all ages from infancy to old age, and is often asymptomatic. This refers to evidence reviewed in 2004. Lower than the licensed starting dose for esomeprazole in gastro-oesophageal reflux disease, which is 40 mg, but considered to be dose-equivalent to other PPIs. These include smoking, alcohol, coffee, chocolate, fatty foods, and being overweight. In either case, prescribe with a PPI. The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. Healthcare professionals should respect an adult’s choice to refuse an endoscopy if they consider themselves to be too frail due to age. Denominator – the number of adults with dyspepsia or reflux symptoms receiving PPI therapy who are tested for. The NICE guideline was developed in association with the Cochrane Collaboration Upper GI and Pancreatic Disease Collaborative Review Group, and Cochrane reviews were used exclusively; new reviews were conducted: peptic ulcer disease and gastro-oesophageal reflux disease (GORD), and existing reviews updated: non-ulcer dyspepsia and initial management strategies. ), 1.3.2 Review medications for possible causes of dyspepsia (for example, calcium antagonists, nitrates, theophyllines, bisphosphonates, corticosteroids and non-steroidal anti-inflammatory drugs [NSAIDs]). Do not offer an upper gastrointestinal contrast study to diagnose or assess the severity of gastro-oesophageal reflux disease in infants, children and young people. [2004], 1.4.6 Offer H2 receptor antagonist (H2RA) therapy if there is an inadequate response to a PPI. [2004], 1.2.4 Recognise that psychological therapies, such as cognitive behavioural therapy and psychotherapy, may reduce dyspeptic symptoms in the short term in individual people. Accident prevention (see unintentional injuries among under-15s), Acute hospitals (adult inpatient wards), safe staffing for nursing, Acute myocardial infarction (see acute coronary syndromes: early management), ADHD (see attention deficit hyperactivity disorder), Adult carers (see supporting adult carers), Adverse drug reactions (see drug allergy), Allergy, food (see food allergy in children and young people), Allergy, severe reaction (see anaphylaxis), Amyotrophic lateral sclerosis (see motor neurone disease), Ankylosing spondylitis (see spondyloarthritis), Antibiotic prescribing for diabetic foot infections (see foot care for people with diabetes), Antibiotics for early-onset neonatal infection (see early-onset neonatal infection), Antibiotics in respiratory tract and ear infections, Antimicrobials for bronchiectasis (non-cystic fibrosis), Antimicrobials for cellulitis and erysipelas, Antisocial personality disorder (see personality disorders), Anxiety (see generalised anxiety disorder), Axial spondyloarthritis (see spondyloarthritis), Behaviour that challenges and learning disabilities, Benign prostatic hyperplasia (see lower urinary tract symptoms in men), Blackouts (see transient loss of consciousness), Bladder infection (see urinary tract infections), Body dysmorphic disorder (see obsessive-compulsive disorder), Borderline personality disorder (see personality disorders), Bowel cancer prevention (see colonoscopic surveillance), Bowel incontinence (see faecal incontinence), Brain cancer (see brain tumours and metastases), Breast cancer, early and locally advanced, Breastfeeding (see maternal and child nutrition), Cancer of unknown primary origin (see metastatic malignant disease of unknown primary origin), Catheter-associated UTIs (see urinary tract infections), Challenging behaviour and learning disabilities, Child maltreatment (see child abuse and neglect), Childbirth (see fertility, pregnancy and childbirth), Children's attachment (see attachment difficulties in children and young people), Children's palliative care, for people with life-limiting conditions (see end of life care for people with life-limiting conditions), Cholelithiasis, cholecystitis and choledocholithiasis (see gallstone disease), Chronic kidney disease, anaemia management, Chronic kidney disease, hyperphosphataemia, Cold homes, reducing preventable excess winter deaths (see excess winter deaths and illnesses associated with cold homes), Colorectal cancer prevention (see colonoscopic surveillance), Community-acquired pneumonia (see pneumonia), Complex psychosis, rehabilitation for adults (see rehabilitation for adults with complex psychosis), Complex social factors and pregnancy: service provision, Conduct disorders and antisocial behaviour in children and young people, Cough (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Criminal justice system, health of people in, Deep vein thrombosis (see venous thromboembolism), Dental perioperative care (see perioperative care), Dental services, local authority improvement approaches (see oral health improvement for local authorities and their partners), Diverticulitis (see diverticular disease), Diverticulosis (see diverticular disease), Dual diagnosis (see coexisting severe mental illness and substance misuse: assessment and management in healthcare settings), Dual diagnosis (see coexisting severe mental illness and substance misuse: community health and social care services), End of life care for infants, children and young people (see end of life care for people with life-limiting conditions), Endocarditis prophylaxis (see prophylaxis against infective endocarditis), Enteral nutrition (see nutrition support in adults), Falls in older people (see preventing falls in older people), Fibroids, uterine (see heavy menstrual bleeding), Fractured neck of femur (see hip fracture), Gastric cancer (see oesophageal and gastric cancer), Gastroenteritis in children (see diarrhoea and vomiting in children), Gastro-oesophageal reflux disease and dyspepsia, Glue ear (see surgical management of otitis media with effusion in children), Gynaecological conditions (see urogenital conditions), Haematemesis (see acute upper gastrointestinal bleeding), Haematological cancers (see blood and bone marrow cancers), Healthcare-associated infections, prevention and control, Heartburn (see dyspepsia and gastro-oesophageal reflux disease), Histology-independent treatment for solid tumours, Hospital-acquired pneumonia (see pneumonia), Hypercholesterolaemia, familial (see familial hypercholesterolaemia), Hypercholesterolaemia, non-familial (see cardiovascular disease prevention), Hyperkinetic disorder (see attention deficit hyperactivity disorder), Incontinence, urinary in neurological disease, Independence and mental wellbeing in older people, Indoor air quality at home (see air pollution), Infant feeding (see maternal and child nutrition), Inflammatory bowel disease (see Crohn's disease), Inflammatory bowel disease (see ulcerative colitis), Interstitial lung disease (see idiopathic pulmonary fibrosis), Intraoperative care (see perioperative care), Labour, care for women with existing medical conditions (see intrapartum care for women with existing medical conditions), Labour, care for women with obstetric complications (see intrapartum care for women with obstetric complications), Larynx, mouth and throat cancer (see upper aerodigestive tract cancer), Learning disabilities, mental health problems, Leukaemia (see blood and bone marrow cancers), Life-limiting conditions, end of life care (see end of life care for people with life-limiting conditions), Lipid modification (see cardiovascular disease prevention), Long-term sickness absence and capability to work, Lymphoma (see blood and bone marrow cancers), Maternity settings, safe midwifery staffing, Medicines adherence (see medicines optimisation), Meningitis, bacterial and meningococcal septicaemia, Menorrhagia (see heavy menstrual bleeding), Mental health disorders (common) in primary care, Mental health services, adult service user experience, Mental illness (severe) and substance misuse, coexisting (see coexisting severe mental illness and substance misuse: community health and social care services), Metabolic conditions (see endocrine, nutritional and metabolic conditions), Monitoring ill patients (see acutely ill patients in hospital), Mouth, larynx and throat cancer (see upper aerodigestive tract cancer), Multiple long-term conditions (see multimorbidity), Multiple pregnancy (see twin and triplet pregnancy), Myalgic encephalomyelitis, chronic fatigue syndrome, Myocardial infarction, secondary prevention and rehabilitation (see acute coronary syndromes: secondary prevention and rehabilitation), Neonatal infection (see early-onset neonatal infection), Neurological disease, urinary incontinence, Nocturnal enuresis (see bedwetting in children and young people), Non-STEMI (see acute coronary syndromes: early management), Nose conditions (see ear, nose and throat conditions), Nutritional conditions (see endocrine, nutritional and metabolic conditions), Older people with social care needs and multiple long-term conditions (see social care for older people with multiple long-term conditions), Older people: independence and mental wellbeing, Otitis media (acute) (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Otitis media with effusion, surgical management in children, Outdoor air quality and health (see air pollution), Overactive bladder (see urinary incontinence), Overweight or obese adults, lifestyle weight management services, Overweight or obese children and young people, lifestyle weight management services, Palliative care, for people with life-limiting conditions (see end of life care for people with life-limiting conditions), Parenteral nutrition (see nutrition support in adults), People with learning disabilities, mental health problems, Postoperative care (see perioperative care), Pre-eclampsia (see hypertension in pregnancy), Pregnancy (see fertility, pregnancy and childbirth), Pregnancy, preventing teenage (see preventing sexually transmitted infections and under-18 conceptions), Pregnancy, twins and triplets (see twin and triplet pregnancy), Premature labour and birth (see preterm labour and birth), Premature ovarian insufficiency (see menopause), Preoperative care (see perioperative care), Psoriatic arthritis (see spondyloarthritis), Psychosis with coexisting substance misuse (see coexisting severe mental illness and substance misuse: assessment and management in healthcare settings), Psychosis, complex, rehabilitation for adults (see rehabilitation for adults with complex psychosis), Pulmonary embolism (see venous thromboembolism), Pyelonephritis (see urinary tract infections), Reactive arthritis (see spondyloarthritis), Renal failure, acute (see acute kidney injury), Renal failure, established (see chronic kidney disease), Renal replacement therapy (see chronic kidney disease), Respiratory syncytial virus infection (see bronchiolitis in children), Respiratory tract and ear infections (self-limiting), antibiotic prescribing, Septicaemia, meningococcal and bacterial meningitis (see bacterial meningitis and meningococcal septicaemia), Severe mental illness and substance misuse, coexisting (see coexisting severe mental illness and substance misuse: community health and social care services), Sexually transmitted infections, prevention, Shoulder replacement (see joint replacement), Sinusitis (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Skin cancer prevention (see sunlight exposure: risks and benefits), Social care services, people's experience, Social factors (complex) in pregnancy: service provision, Sore throat (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Spinal cord compression, metastatic (see metastatic spinal cord compression), STEMI (see acute coronary syndromes: early management), Stomach cancer (see oesophageal and gastric cancer), Substance misuse and severe mental illness, coexisting (see coexisting severe mental illness and substance misuse: community health and social care services), Surgical site infection (see prevention and control of healthcare-associated infections), Suspected neurological conditions recognition and referral (see neurological conditions), Teenage pregnancy prevention (see preventing sexually transmitted infections and under-18 conceptions), Termination of pregnancy (see abortion care), Throat conditions (see ear, nose and throat conditions), Throat, larynx and mouth cancer (see upper aerodigestive tract cancer), Tobacco cessation (smokeless): South Asian communities, Type 1 and type 2 diabetes in children and young people, Unstable angina (see acute coronary syndromes: early management), Urological conditions (see urogenital conditions), Vaccinations (see immunisation for children and young people), Weight management services (lifestyle) for overweight or obese adults, Weight management services (lifestyle) for overweight or obese children and young people, Winter deaths and illnesses associated with cold homes (see excess winter deaths and illnesses associated with cold homes), Young offender institutions, health of people in, Gastro-oesophageal reflux in children and young people, Continued non-steroidal anti-inflammatory drug use, assess and reduce the environmental impact of implementing NICE recommendations, Gastro-oesophageal reflux disease in children and young people: diagnosis and management, Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management, Laparoscopic insertion of a magnetic titanium ring for gastro-oesophageal reflux disease, Electrical stimulation of the lower oesophageal sphincter for treating gastro-oesophageal reflux disease, Endoscopic radiofrequency ablation for gastro-oesophageal reflux disease, Endoluminal gastroplication for gastro-oesophageal reflux disease, Endoscopic augmentation of the lower oesophageal sphincter using hydrogel implants for the treatment of gastro-oesophageal reflux disease, Endoscopic injection of bulking agents for gastro-oesophageal reflux disease, Cytosponge for detecting abnormal cells in the oesophagus, Narrow band imaging for Barrett's oesophagus, Stretta System for gastro-oesophageal reflux disease, Peptest for diagnosing gastro-oesophageal reflux, gastro-oesophageal reflux in children and young people quality standard, dyspepsia and gastro-oesophageal reflux disease in adults quality standard, Gastro-oesophageal reflux disease in children and young people, gastro-oesophageal reflux disease in children and young people, meningitis (bacterial) and meningococcal septicaemia in under 16s, Geographic patterns of cancer survival in England, British National Formulary section 1.3.5 Proton pump inhibitors, UK Standards for Microbiology Investigations, UK Standards for Microbiology Investigations – SMI Q1: Commercial and in-house diagnostic tests: evaluations and validations, BOB CAT: a large-scale review and Delphi consensus for management of Barrett’s Esophagus with no dysplasia, indefinite for, or low-grade dysplasia, Treating gastro-oesophageal reflux disease using an endoscope and electrical heat energy, Treating gastro-oesophageal reflux by stitching folds into the stomach reached through the mouth, Catheterless monitoring of oesophageal acidity, the NICE Pathway on urinary tract infections, the NICE Pathway on food allergy in under 19s, the NICE Pathway on bacterial meningitis and meningococcal septicaemia in under 16s, is very common (it affects at least 40% of infants), usually begins before the infant is 8 weeks old, may be frequent (5% of infants affected have 6 or more episodes each day), usually becomes less frequent with time (it resolves in 90% of affected infants before they are 1 year old). Evidence of local arrangements to ensure that upper GI contrast studies are not used to diagnose or assess the severity of GORD in infants, children and young people. Other factors that might help, such as raising the head of the bed and having a main meal at least 3 hours before going to bed. Subject to Notice of rights. It is important to use an accurate test for. Breast-fed infants with frequent regurgitation associated with marked distress have their feeding assessed. Patient-reported health outcomes for adults with dyspepsia or gastro-oesophageal reflux disease. Proportion of infants, children and young people prescribed domperidone, metoclopramide or erythromycin to manage GOR or GORD on the basis of specialist paediatric advice. The full guideline gives details of the methods and the evidence used to develop the guidance. Adults with uninvestigated dyspepsia or reflux symptoms should try a full dose proton pump inhibitor (PPI) for a month and, if there is an inadequate response, H, Endoscopy should not routinely be offered to diagnose Barrett’s oesophagus. Primary care arranges for a non-urgent endoscopy to be carried out and retains clinical responsibility throughout, including acting on the result. [2004], 1.8.7 Avoid long-term, frequent dose, continuous antacid therapy (it only relieves symptoms in the short term rather than preventing them). [2004, amended 2014], 1.4.2 Leave a 2‑week washout period after proton pump inhibitor (PPI) use before testing for Helicobacter pylori (hereafter referred to as H pylori) with a breath test or a stool antigen test. Dyspepsia describes a range of symptoms arising from the upper gastrointestinal (GI) tract, but it has no universally accepted definition. [2004, amended 2014], 1.7.10 Offer H2RA therapy if there is an inadequate response to a PPI. By reacting with acidic gastric contents the alginate forms a viscous gel that stabilises stomach activity which results in reducing the incidence of GOR. dyspepsia guideline has been developed to update the statement with essential practical points, rationales, levels of evidence, and grades of recommendations for the management of dyspepsia. Infants have alginate therapy for a period of 1–2 weeks to assess if GOR improves. Infants, children and young people with vomiting or regurgitation and any ‘red flag’ symptoms are referred to specialist care with investigations as appropriate. [2004] (Also see the NICE guideline on acute upper gastrointestinal bleeding. These include smoking, alcohol, coffee, chocolate, fatty foods and being overweight. [2004], 1.1.2 Community pharmacists should record adverse reactions to treatment and may participate in primary care medication review clinics. Upper GI contrast studies are neither sensitive nor specific enough to diagnose or assess the severity of GORD, and they unnecessarily expose infants, children and young people to radiation. The literature has been reviewed and evidence-based updated recommendations are provided. Stanghellini,V., Cogliandro,R. [new 2014]. Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. a) Proportion of breast-fed infants with frequent regurgitation associated with marked distress that continues despite a feeding assessment and advice who have a trial of alginate therapy. [3] This refers to evidence reviewed in 2004. The recommendations on how to assess a person with uninvestigated dyspepsia are largely based on the National Institute for Health and Care Excellence (NICE) clinical guideline Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management and have also been extrapolated from expert opinion in the World Gastroenterology Organisation (WGO) guideline Global perspective on gastroesophageal reflux disease … These recommendations apply to adults (aged 18 and over) with symptoms of dyspepsia, symptoms suggestive of gastro-oesophageal reflux disease (GORD), or both. [2004]. Sorry, the requested activity is no longer available for participation. Dyspepsia: Management of dyspepsia in adults in primary care. In formula-fed infants, thickened formula should be stopped before alginate therapy is offered. [2004, amended 2014], 1.5.2 Advise people that it may be appropriate for them to return to self‑treatment with antacid and/or alginate therapy (either prescribed or purchased over-the-counter and taken as needed). The following points may be incorporated into local information materials for patients with dyspepsia. reduce the feed volumes only if excessive for the infant’s weight, then, offer a trial of smaller, more frequent feeds (while maintaining an appropriate total daily amount of milk) unless the feeds are already small and frequent, then. Filter Toggle filter panel Evidence type Add filter for Guidance and Policy (375) Add ... (NICE), 12 November 2014 Gastroenterology (CAG) guidelines on dyspepsia in a joint ACG/CAG dyspepsia guideline. Breastfeeding assessments should be carried out in a culturally appropriate manner and any messages communicated in a sensitive way. [2004], 1.7.9 If symptoms recur after initial treatment, offer a PPI to be taken at the lowest dose possible to control symptoms.

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