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afya
Dyspepsia
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> ''2004 NICE guidance'' 2WW if red flags or >55yr with new, unexplained or persistent Sx of dyspepsia ''Red flags'' Chronic GI bleeding Progressive unintentional weight loss progressive difficulty swallowing persistent vomiting iron deficiency anaemia epigastric mass suspicious barium meal ''Think'' - NSAID, Hpylori, anxiety, IBS, GORD ''Mx'' if no red flags, doesn't need routine endoscopy Review meds for cause - NSAID Lifestyle advice step up is cheaper - antacids, H2RA, PPI - 4/52 at each stage as to Sx - do need trial of full dose PPI 1/12 Test for Hpylori - can do treat and test or test and treat .... also test if .... dyspepsia without response to lifestyle and 1/12 PPI, Hx peptic ulcer, Hx long term NSAID use, Iron or B12 deficiency or ITP C13 breath test (debate if do pre PPI as must be off PPI 2/52 to do (and no Abs within 4/52)) and treat if pos Note ... erosive oesophagitis - 13% peptic ulcer disease - 8% Ca - 0.3% functional 70-80%
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