Entry to pathway

1
Ealing Dyspepsia Integrated Care Pathway
Entry to pathway Patient presenting to GP with
New or repeat Dyspepsia Type Symptoms
Yes
Positive ()
H.pylori Eradication therapy 7 days
Symptoms resolved
No further treatment. If symptoms recur re-enter
pathway.

• Ulcer type Dyspepsia offer H.pylori test
• Stool antigen or C13 Urea breath test

No
No
Negative(-)
Alarm symptoms
1.Lifestyle Advise 2.Prescribe 4 week course of
lansoprazole 30mg caps od or Omeprazole 20mg caps
od and review
Reflux type Dyspepsia symptoms
Yes

• Dysphagia or Odynophagia
• Epigastric mass
• Unintentional weight loss 3kg
• Unexplained iron deficiency anaemia
• Abnormal barium result
• Persistent continued vomiting

STOP treatment or Step Down to lowest dose that
controls symptoms eg Lansoprazole 15mg or
Omeprazole 10mg. Review annually. If symptoms
return re-enter pathway.
Yes
Symptoms resolved
No
Prescribe 4 week course of Esomeprazole 40mg od
and review

• Evidence of GI Blood loss e.g
• Haematemesis
• Malena stools
• Immediate referral to Secondary Care

Refer to Secondary Care under 2 week wait guidance
Yes
Symptoms resolved
STEP DOWN to lowest dose PPI that controls
symptoms eg Esomeprazole 20mg od Omeprazole 20mg
od. Review annually. If symptoms return re-enter
pathway.
No
H pylori Testing Treatment Testing faecal
testing or C13 Urea Breath Test Treatment
Lansoprazole 30mg bd /Ompeprazole 20mg bd
Clarithromycin 500mg bd amoxicillin 1g bd
regime for 7 days. For Penicillin sensitive
patients substitute Metronidazole 400mg bd
Amoxicillin
Refer to Secondary Care for opinion

• Lifestyle Advise
• - Weight loss if necessary
• Stop smoking
• Avoid large meals excessive volume of fluids.
  In particular avoid fatty/spicy foods, excessive
  amounts of alcohol, caffeine or chocolate.

PPI Advice Lansoprazole 30mg capsules or
Omeprazole 20mg capsules are the recommended
treatment PPI for new patients. Esomeprazole is
recommended only for patients who fail to respond
to the above regime. Patients should have their
treatment regularly reviewed and stepped down or
stopped as appropriate.