Guidance

Key priorities for implementation

Key priorities for implementation

The following recommendations have been identified as priorities for implementation. The full list of recommendations is in the recommendations section.

Referral guidance for endoscopy

Interventions for uninvestigated dyspepsia

  • Leave a 2-week washout period after proton pump inhibitor (PPI) use before testing for Helicobacter pylori (hereafter referred to as H pylori) with a breath test or a stool antigen test. [2004, amended 2014]

Interventions for gastro-oesophageal reflux disease

  • Offer people a full-dose PPI (see table 2 in appendix A) for 8 weeks to heal severe oesophagitis, taking into account the person's preference and clinical circumstances (for example, underlying health conditions and possible interactions with other drugs). [new 2014]

  • Offer a full-dose PPI (see table 2 in appendix A) long-term as maintenance treatment for people with severe oesophagitis, taking into account the person's preference and clinical circumstances (for example, tolerability of the PPI, underlying health conditions and possible interactions with other drugs), and the acquisition cost of the PPI. [new 2014]

  • Do not routinely offer endoscopy to diagnose Barrett's oesophagus, but consider it if the person has gastro-oesophageal reflux disease (GORD). Discuss the person's preferences and their individual risk factors (for example, long duration of symptoms, increased frequency of symptoms, previous oesophagitis, previous hiatus hernia, oesophageal stricture or oesophageal ulcers, or male gender). [new 2014]

Interventions for peptic ulcer disease

  • Offer H pylori eradication therapy to people who have tested positive for H pylori and who have peptic ulcer disease. Also see the section on H pylori testing and eradication. [2004]

  • For people using non-steroidal anti-inflammatory drugs (NSAIDs) with diagnosed peptic ulcer, stop the use of NSAIDs where possible. Offer full-dose PPI (see table 1 in appendix A) or H2 receptor antagonist (H2RA) therapy for 8 weeks and, if H pylori is present, subsequently offer eradication therapy. [2004]

  • Offer people with peptic ulcer (gastric or duodenal) and H pylori retesting for H pylori 6 to 8 weeks after beginning treatment, depending on the size of the lesion. [2004, amended 2014]

Referral to a specialist service

  • Consider referral to a specialist service for people:

    • of any age with gastro-oesophageal symptoms that are non-responsive to treatment or unexplained (in the NICE guideline on suspected cancer: recognition and referral, 'unexplained' is defined as 'symptoms or signs that have not led to a diagnosis being made by the healthcare professional in primary care after initial assessment [including history, examination and any primary care investigations]')

    • with suspected GORD who are thinking about surgery

    • with H pylori that has not responded to second-line eradication therapy. [new 2014]

Surveillance for people with Barrett's oesophagus

  • Consider surveillance to check progression to cancer for people who have a diagnosis of Barrett's oesophagus (confirmed by endoscopy and histopathology), taking into account:

    • the presence of dysplasia (also see the NICE guideline on Barrett's oesophagus and stage 1 oesophageal adenocarcinoma)

    • the person's individual preference

    • the person's risk factors (for example, male gender, older age and the length of the Barrett's oesophagus segment).

      Emphasise that the harms of endoscopic surveillance may outweigh the benefits in people who are at low risk of progression to cancer (for example, people with stable non-dysplastic Barrett's oesophagus). [new 2014]