Functional Dyspepsia 2022 UK guidelines Part1

[gmohan]

Executive summary of recommendations
Doctor–patient communication, diagnosis and investigation of functional dyspepsia
Clinicians should be aware that most patients with dyspepsia will have functional dyspepsia (FD) as the underlying cause of their symptoms after investigation (recommendation: strong, quality of evidence: low).

We recommend that, in the absence of upper gastrointestinal alarm symptoms or signs, clinicians should diagnose FD in the presence of bothersome epigastric pain or burning, early satiation and/or postprandial fullness of greater than 8 weeks duration (recommendation: strong, quality of evidence: very low).

Establishing an effective and empathic doctor–patient relationship and a shared understanding is key to the management of FD. This may reduce healthcare utilisation and improve quality of life (recommendation: strong, quality of evidence: very low).

We recommend that the diagnosis of FD, its underlying pathophysiology and the natural history of the condition, including common symptom triggers, should be explained to the patient. FD should be introduced as a disorder of gut–brain interaction (DGBI), together with a simple account of the gut–brain axis and how this is impacted by diet, stress, cognitive, behavioural and emotional responses to symptoms and postinfective changes (recommendation: strong, quality of evidence: very low).

We recommend that a full blood count is performed in patients aged ≥55 years with dyspepsia and coeliac serology in all patients with FD and overlapping irritable bowel syndrome (IBS)-type symptoms (recommendation: strong, quality of evidence: low).

We recommend that if no other upper gastrointestinal alarm symptoms or signs are reported, urgent endoscopy is only warranted in patients aged ≥55 years with dyspepsia with weight loss, or those aged >40 years from an area at an increased risk of gastric cancer or with a family history of gastro-oesophageal cancer (recommendation: strong; quality of evidence: very low).

We recommend that non-urgent endoscopy is considered in patients aged ≥55 years with treatment-resistant dyspepsia or dyspepsia with either a raised platelet count or nausea or vomiting (recommendation: strong, quality of evidence: very low).

Part 2 to follow

We recommend that urgent abdominal CT scanning is considered in patients aged ≥60 years with abdominal pain and weight loss to exclude pancreatic cancer (recommendation: strong; quality of evidence: very low).

We recommend that all other patients with dyspepsia are offered non-invasive testing for Helicobacter pylori (‘test and treat’) and, if infected, given eradication therapy (recommendation: strong; quality of evidence: high).

We recommend that successful eradication of H. pylori after ‘test and treat’ is only confirmed in patients with an increased risk of gastric cancer (recommendation: strong; quality of evidence: low).

We recommend that patients without H. pylori infection are offered empirical acid suppression therapy (recommendation: strong; quality of evidence: high).

Referral of patients with FD to gastroenterology in secondary care is appropriate where there is diagnostic doubt, where symptoms are severe, or refractory to first-line treatments, or where the individual patient requests a specialist opinion (recommendation: weak, quality of evidence: low).

We recommend that gastric emptying testing or 24-hour pH monitoring should not be undertaken routinely in patients with typical symptoms of FD (recommendation: strong, quality of evidence: very low).

We recommend that, ideally, patients with FD referred to secondary care are managed in a specialist clinic, with access to an interested clinician, dietetic and lifestyle support, with access to efficacious drugs and gut–brain behavioural therapies. Rates of H. pylori ‘test and treat’ prior to endoscopy, prevalence of H. pylori infection and use of endoscopy should be audited (recommendation: strong, quality of evidence: very low).