How should I approach the management of dyspepsia in patients with alarm symptoms?

Approach to managing dyspepsia in patients presenting with alarm symptoms:

• Immediately assess for alarm symptoms such as significant acute gastrointestinal bleeding, weight loss, treatment-resistant dyspepsia in those aged 55 and over, low haemoglobin, raised platelet count, persistent nausea or vomiting, or other signs suggestive of serious underlying pathology including upper gastrointestinal cancer.

• For patients with significant acute gastrointestinal bleeding, refer immediately on the same day to a specialist for urgent management.

• For patients aged 55 and over with treatment-resistant dyspepsia or dyspepsia accompanied by weight loss, refer urgently using a suspected cancer pathway referral for upper gastrointestinal endoscopy.

• For patients aged 55 and over with dyspepsia plus low haemoglobin, raised platelet count, nausea, or vomiting, consider non-urgent direct access upper gastrointestinal endoscopy.

• Review and suspend any medications that may exacerbate dyspepsia symptoms, such as NSAIDs, if appropriate.

• Consider differential diagnoses including cardiac or biliary disease.

• Offer written information and advice on symptoms, self-care, and lifestyle modifications, but prioritise urgent investigation and referral in the presence of alarm symptoms.

These steps ensure timely identification and management of serious pathology while providing supportive care for dyspepsia symptoms.