Guidance Dyspepsia and Gastrooesophageal Reflux Disease PDF

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Guideline dispepsia

Transcript of Guidance Dyspepsia and Gastrooesophageal Reflux Disease PDF

  • Dyspepsia and gastro-oesophagealreflux disease

    Investigation and management of dyspepsia,symptoms suggestive of gastro-oesophagealreflux disease, or both

    Issued: September 2014 last modified: November 2014

    NICE clinical guideline 184guidance.nice.org.uk/cg184

    NICE has accredited the process used by the Centre for Clinical Practice at NICE to produceguidelines. Accreditation is valid for 5 years from September 2009 and applies to guidelines producedsince April 2007 using the processes described in NICE's 'The guidelines manual' (2007, updated2009). More information on accreditation can be viewed at www.nice.org.uk/accreditation

    NICE 2014

  • ContentsIntroduction .................................................................................................................................. 4

    Drug recommendations........................................................................................................................... 5

    Patient-centred care ..................................................................................................................... 6

    Key priorities for implementation .................................................................................................. 7

    Referral guidance for endoscopy ............................................................................................................ 7

    Interventions for uninvestigated dyspepsia ............................................................................................. 7

    Interventions for gastro-oesophageal reflux disease (GORD) ................................................................ 7

    Interventions for peptic ulcer disease...................................................................................................... 8

    Referral to a specialist service ................................................................................................................ 8

    Surveillance for people with Barrett's oesophagus ................................................................................. 8

    1 Recommendations .................................................................................................................... 10

    Terms used in this guideline .................................................................................................................... 10

    1.1 The community pharmacist ............................................................................................................... 10

    1.2 Common elements of care ................................................................................................................ 10

    1.3 Referral guidance for endoscopy ...................................................................................................... 11

    1.4 Interventions for uninvestigated dyspepsia ....................................................................................... 12

    1.5 Reviewing patient care ...................................................................................................................... 12

    1.6 Interventions for gastro-oesophageal reflux disease (GORD) .......................................................... 13

    1.7 Interventions for peptic ulcer disease................................................................................................ 14

    1.8 Interventions for functional dyspepsia ............................................................................................... 15

    1.9 Helicobacter pylori testing and eradication ....................................................................................... 16

    1.10 Laparoscopic fundoplication............................................................................................................ 18

    1.11 Referral to a specialist service......................................................................................................... 19

    1.12 Surveillance for people with Barrett's oesophagus ......................................................................... 19

    2 Research recommendations ..................................................................................................... 21

    Dyspepsia and gastro-oesophageal reflux disease NICE clinical guideline 184

    NICE 2014. All rights reserved. Last modified November 2014 Page 2 of 43

  • 2.1 Patient characteristics, risk factors and predictors that indicate endoscopy for excluding Barrett'soesophagus............................................................................................................................................. 21

    2.2 Laparoscopic fundoplication compared with medical management .................................................. 21

    2.3 Effective proton pump inhibitor dosage for severe erosive reflux disease ........................................ 22

    2.4 Other specialist management ........................................................................................................... 22

    2.5 Specialist investigation ...................................................................................................................... 23

    3 Other information....................................................................................................................... 24

    3.1 Scope and how this guideline was developed .................................................................................. 24

    3.2 Related NICE guidance..................................................................................................................... 24

    4 The Guideline Development Group, NICE Internal Clinical Guidelines Programme and NICEproject team.................................................................................................................................. 26

    4.1 Guideline Development Group.......................................................................................................... 26

    4.2 Expert advisers to the group ............................................................................................................. 27

    4.3 NICE Internal Clinical Guidelines Programme .................................................................................. 27

    4.4 NICE project team............................................................................................................................. 29

    Appendix A: Dosage information on proton pump inhibitors ........................................................ 30

    Changes after publication............................................................................................................. 32

    About this guideline ...................................................................................................................... 33

    Update information.................................................................................................................................. 33

    Recommendations from NICE clinical guideline 17 that have been amended ....................................... 34

    Strength of recommendations ................................................................................................................. 41

    Other versions of this guideline ............................................................................................................... 42

    Implementation........................................................................................................................................ 43

    Your responsibility ................................................................................................................................... 43

    Copyright ................................................................................................................................................. 43

    Dyspepsia and gastro-oesophageal reflux disease NICE clinical guideline 184

    NICE 2014. All rights reserved. Last modified November 2014 Page 3 of 43

  • Introduction

    This guideline updates and replaces 'Dyspepsia' (NICE clinical guideline 17). See about thisguideline for details.

    Dyspepsia describes a range of symptoms arising from the upper gastrointestinal (GI) tract, but ithas no universally accepted definition. The British Society of Gastroenterology (BSG) definesdyspepsia as a group of symptoms that alert doctors to consider disease of the upper GI tract,and states that dyspepsia itself is not a diagnosis. These symptoms, which typically are presentfor 4 weeks or more, include upper abdominal pain or discomfort, heartburn, gastric reflux,nausea or vomiting. In this guideline, gastro-oesophageal reflux disease (GORD) refers toendoscopically determined oesophagitis or endoscopy-negative reflux disease.

    Some of the costs associated with treating dyspepsia are decreasing, but the overall use oftreatments is increasing. As a result, the management of dyspepsia continues to have potentiallysignificant costs to the NHS.

    The use of endoscopy has increased considerably over the past decade, as awareness of itsvalue in investigating dyspepsia and GORD has grown.

    The review of 'Dyspepsia: management of dyspepsia in adults in primary care' (NICE clinicalguideline 17) highlighted some concerns about the drug regimens that were recommended in theguideline for Helicobacter pylori (hereafter referred to as H pylori) eradication, because somebacterial resistance has developed. Overall, the review process concluded that some guidance inthis area should be updated and expanded to cover aspects of specialist hospital care.

    NICE clinical guideline 17 covered the management of several underlying causes of dyspeps