Flow Chart

Diagnostic flow chart for patients presenting with dyspepsia [BSG Dyspepsia Management Guidelines, April 2003]
FIGURE 1 – Diagnostic flow chart
for patients presenting with dyspepsia
[BSG Dyspepsia Management Guidelines,
April 2003] (click to enlarge)

The flowchart shown in Figure 1, an adaptation of the current National Institute of Clinical Excellence (NICE) Guidelines for management of Dyspepsia in adults in primary care,(Aug 2004), and serves as an example of what diagnostic steps could be taken when a patient presents with symptoms of dyspepsia. View NICE guidelines (link to nice guidelines PDF attached)

The following notes refer to Figure 1:

(A) Alarm symptoms and signs:

  • Unintentional weight loss (>3kg)
  • Unexplained iron deficiency anaemia
  • GI bleeding
  • Dysphagia and odynophagia
  • Previous gastric surgery
  • Persistent continuous vomiting
  • Epigastric mass
  • Suspicious barium meal
  • Previous gastric ulcer
  • NSAID use
  • No response to H2-receptor antagonists

(B) H. pylori infection can be detected by several invasive or non-invasive methods, including:

  • Antibody/antigen testing of blood, urine or saliva (using ELISA).
  • The urea breath test measures carbon dioxide gas in exhaled air. The patient drinks a solution of urea containing radiolabelled carbon. Any H. pylori present produces urease to metabolise the urea, the radiolabelled carbon is released and exhaled as carbon dioxide by the patient.
  • Tissue samples removed during endoscopy can be examined in three ways; the urease test can identify the presence of this enzyme produced by the bacterium, the histology test allows identification of the bacterium itself, and a culture test can be used to grow H. pylori.

(C)

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