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NICE updates guidance on treating digestive disorders

Guidance on digestive disorders is being updated by the National Institute for Health and Care Excellence amid concerns that patients with potentially serious conditions are not receiving optimum levels of care.

NICE is developing consistent new advice for the whole of the health service to treat people with dyspepsia, a group of symptoms that can be caused by medical problems such as stomach ulcers, gastro-oesophageal reflux disease (GORD) and Barrett’s oesophagus.

It is believed that almost half of all UK adults will experience dyspepsia − as defined by the British Society of Gastroenterology − each year.

NICE published its original guidance for GPs and community pharmacists in 2004, but since then it has become clear it should be extended to cover hospitals and other secondary care settings.

Updated recommendations on the care of people with digestive disorders have now been drafted and will go out for consultation.

“New evidence has come to light regarding the cost and most effective use of treatments and diagnostic equipment”

Gillian Leng

Professor Gillian Leng, deputy chief executive and director of health and social care at NICE, said indigestion or dyspepsia can affect millions of people each year and can be a “distressing” condition.

“Although most cases will be relatively minor, it can be a symptom of more serious conditions, which might, in some cases, be cancer,” she added.

“Since the last guideline was published, new evidence has come to light regarding the cost and most effective use of treatments and diagnostic equipment.

Gillian Leng

“By updating our guideline and extending it to cover both primary and secondary care, we will continue to support the NHS to provide the highest possible quality of care in the most effective manner,” she added.

As part of the new recommendations, healthcare professionals should consider referral to a specialist service for certain patients with gastro-oesophageal symptoms that are persistent, non‑responsive to treatment or unexplained with suspected GORD, and where second-line treatment has been ineffective.

Another important recommendation is to not routinely offer endoscopy to diagnose Barrett’s oesophagus, but consider it if the person has GORD.

In addition, NICE recommended that patients with severe oesophagitis are offered a full-dose proton pump inhibitor for eight weeks, taking into account the individual’s preference and clinical circumstances, including whether there are underlying health conditions or possible interactions with other drugs.

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