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Safer Care Victoria’s Best Care resources support patients and healthcare providers to have conversations and make decisions together about the most appropriate pathways for care.

This resource, developed for clinicians, details a specific elective surgery procedure that should now only be done for specific indications. Evidence-based recommendations that detail ‘best care’ pathways should be discussed with your patient to determine the most appropriate pathway of care.

Advice

A gastroscopy is not indicated as first-line management for dyspepsia in a person aged 18-55 with no red flag symptoms, abnormal results of gastrointestinal related blood tests and/or imaging.

Red flag symptoms include dysphagia, iron deficiency anaemia, other nutritional anaemia, abnormal weight loss, anorexia, early satiety, personal or family history of cancer of the digestive system, and development of peptic ulcer disease in the previous 12 months. Other red flags include abnormal blood tests and imaging.

 

When is the procedure indicated?

For a person aged between 45 and 55 with a recent onset of persistent dyspepsia symptoms with no red flag features, the risk of upper gastrointestinal malignancy becomes likely enough to warrant a gastroscopy.

Best care recommendations

Initial trial of a 6 week course of a protein pump inhibitor or other medical treatment is recommended.

H. pylori testing should be considered as part of the initial assessment of patients under 55 who have dyspepsia with no additional symptoms or abnormal blood tests.  A test and treat approach is recommended.

Patients with H. pylori-associated dyspepsia under the age of 55 which resolves after H. pylori eradication do not require upper gastrointestinal endoscopy unless there are red flag symptoms or results.

Patients should be referred for an upper gastrointestinal endoscopy if symptoms persist after treatment.

Evidence

Department of Health and Human Services. Specialist clinics resources: The Victorian Endoscopy Categorisation Decision Support Tool [Internet]. Melbourne (VIC): Department of Health and Human Services; 2017 [cited 2020 Nov 20].

Ford AC, Moayyedi P. Dyspepsia. BMJ. 2013 Aug 29;347:f5059.

Shaukat A, Wang A, Acosta RD, Bruining DH, Chandrasekhara V, Chathadi KV, et al. The role of endoscopy in dyspepsia. Gastrointestinal Endoscopy. 2015 Aug 1;82(2):227-32.

Page last updated: 08 Feb 2021

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