Scope for the development of a clinical guideline on the primary management of dyspepsia

Untitled Document

Scope for the development of a clinical guideline on the primary management of dyspepsia

Version 3d (Final)

1. Introduction

The National Institute for Clinical Excellence is responsible for developing and disseminating clinical guidelines to provide advice on best practice for patients and health professionals in the NHS in England and Wales.

2. Title

The primary management of dyspepsia.

3. Summary

Dyspepsia affects up to 40% of the adult population in any one year. There is currently considerable uncertainty in clinical practice. This guideline will address the primary management of dyspepsia including diagnosis, referral and pharmacological and non-pharmacological interventions.

4. Clinical Need and Practice

  • Dyspepsia refers to a broad range of symptoms related to dysfunction of the upper gastrointestinal (GI) tract from the oesophagus to the duodenum, including retrosternal or epigastric pain, fullness, bloating, wind, heartburn, nausea and vomiting. Pain may vary from mild to severe, may be intermittent and may often resolve itself without medication. The main causes are gastro-oesophageal reflux disease (GORD) (15-25%), gastric and duodenal ulcers (15-25%) and stomach cancer (2%). The remaining 60% are classified as non-ulcer dyspepsia (NUD), also called "functional" dyspepsia.
  • It is estimated that up to 40% of the adult population suffer from dyspepsia in any one year. About 10% of the population seek their general practitioner's advice for dyspeptic symptoms each year and about 10% of these are referred on for a specialist opinion.
  • There is recognised uncertainty in clinical practice, resulting from conflicting professional advice and the continued emergence of new research evidence on the most cost-effective management strategies
  • Large numbers of people use over-the-counter medication.

5. Inclusions and exclusions of the guideline

5.1. Disease or condition

  • The guideline will cover diagnosis and primary management of dyspepsia in adults of all ages. The guideline will include the interpretation of clinical symptoms and the appropriate use of investigations (e.g. endoscopy) to inform diagnosis and management.

5.2. Health care setting and profession

  • The guideline will be of relevance to clinicians in primary and secondary care who have direct contact with and make decisions concerning the diagnosis and primary management of patients with dyspepsia. The guideline will address practice for community pharmacists in addition to the primary health care team

5.3. Interventions and treatment modalities

The guideline development will include

the sequential primary management of patients including investigations and treatment.

pharmacological interventions including those prescribed and over-the-counter

the Institute's guidance on proton pump inhibitors (PPIs) used in treatment of dyspepsia.

H Pylori testing and eradication

management and prevention of drug-induced dyspepsia (e.g. NSAIDs and corticosteroids)

guidance on referral which may be from primary to secondary care or onwards within secondary care

self care considering the evidence of effectiveness of, for example, smoking cessation, weight reduction, diet and over-the-counter medications.

information to patients on treatments including their advantages and disadvantages.

The guideline development will not address the management of more serious underlying causes of dyspepsia (such as malignancies and perforated ulcers) but will describe the tests and investigations required to make these diagnoses.

6. Status

This scoping statement has been subject to a period of consultation and discussed with stakeholders. This is now the final draft and is posted on the Institute's website along with details of the commission and the developers of the guideline when available.

This page was last updated: 30 March 2010

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.