Decision-making in dyspepsia

Criteria for Referring Patients With Outpatient Gastroenterological Disease for Specialist Consultation: A Review of the Literature

“…Criteria for referral were most commonly listed for suspected colorectal cancer[8, 10, 12, 13, 15-20, 22, 23, 25, 27, 28, 30, 31, 33, 35, 36, 38, 40]. Other GI conditions for which some referral criteria were found included suspected upper GI cancer[9, 24, 25, 27-30, 38, 39], hepatitis[11, 14, 26, 30], and functional disorders such as irritable bowel syndrome, dyspepsia, diarrhoea and constipation[21, 30, 32, 34, 37]. We found four papers on the management of a variety of important GI conditions, but they did not contain criteria for referral: inflammatory bowel disease[42], pancreatitis [43-44] and acute gastrointestinal blood loss[45].…”

“…In patients with dyspepsia, Tytgat et al [37] summarized risk factors that should prompt the referral of these patients for early endoscopy: the presence of alarm symptoms (anaemia or evidence of bleeding, severe or persistent pain, painful swallowing, difficulty swallowing, recurrent or persistent vomiting, anorexia, weight loss); presentation with first-time dyspepsia or altered symptoms over the age of 55; previous history of peptic ulcer disease; current ulcer disease and recent evidence of substantial gastrointestinal bleeding; use of NSAIDs; and other risk factors (heavy smoking, alcohol abuse). Reflux-like symptoms (regurgitation, reflux or heartburn) have been shown to have a 33% positive predictive value for finding reflux oesophagitis during open-access endoscopy [39].…”