Experts in this area have concluded that all patients under the age of 55 with no alarm symptoms
who present with uninvestigated dyspepsia should be tested for H pylori, using breath testing or stool antigen testing.
He believes that all patients with alarm symptoms
should be scoped urgently, but those without should be given at least one trial of dietary change or medication before moving to endoscopy.
This study enrolled 699 adults with general symptoms of epigastric pain, heartburn, or both, lasting for at least 4 weeks but without alarm symptoms
The guidelines recommend gastroenterology consultation or upper endoscopy to rule out neoplastic or pre-neoplastic lesions if alarm symptoms
(TABLE) suggesting complicated GERD are present.
A family physician, for example, may be less likely to see patients with alarm symptoms
than a specialist.
FAST TRACK Routine diagnostic testing is not recommended for patients without alarm symptoms
or signs of organic disorder
A common primary care strategy for patients with dyspepsia and no alarm symptoms
is to prescribe a proton-pump inhibitor.
For patients aged <50 years without alarm symptoms
, diagnostic testing is unnecessary.
The American College of Gastroenterology recommends EGD for GERD patients who do not respond to therapy, experience alarm symptoms
, who have chronic symptoms and are at risk for Barrett's esophagus, and need continuous chronic therapy.
Evidence supports a "test and treat" approach for the initial management of patients younger than 45 years who do not have alarm symptoms
for malignancy or complicated disease and immediate endoscopy for patients older than 45 years or who have alarm symptoms
The protocol excluded patients with dysmotility and untypeable dyspepsia, patients with dysmotility and other types of dyspepsia, and those with a history of peptic ulcer disease, reflux esophagitis, alarm symptoms
(weight loss, dysphagia, bloody or black stools, anemia, jaundice), or current nonsteroidal anti-inflammatory drug use.