Reflux/Heartburn/Dyspepsia

This condition is treated in the Gastroenterology clinic.

Pre-referral work-up

History

All referrals should comply to referral standards and include in particular:

• Family history of gastrointestinal cancers
• Relevant medications
• Medical management to date (document treatments offered and efficacy including failed treatment with moderate dose PPI for dyspepsia)

Tests

Pathology:

FBC

LFT

U&E

Imaging:

Any relevant

Investigations:

Nil

Interim/GP management

To refer a patient with this condition, please see the Gastroenterology clinic page for the full referral process and templates.

Recommended pre-referral treatment

Lifestyle Changes: Reduce fatty foods, avoid trigger foods (food diary), weight reduction, smoking cessation, and limit alcohol.

Medical Management:Consider Helicobacter treatment if serology or breath test is positive*: Please note that this may not be covered by Medicare.

*The test-and-treat strategy for H. pylori (i.e. test and treat if positive) is a proven management strategy for patients with uninvestigated dyspepsia who are under the age of 55 years and have no – alarm features" (bleeding, anaemia, early satiety, unexplained weight loss, progressive dysphagia, odynophagia, recurrent vomiting, family history of GI cancer, previous oesophagogastric malignancy).

Otherwise:

• Cease any aggravating medications if possible e.g. NSAIDS, aspirin
• A symptom based diagnosis for gastroesophageal reflux can be supplemented by a 2-4 week trial of high dose PPI which has a sensitivity and specificity for reflux disease comparable to oesophageal PH monitoring and superior to endoscopy
• Trial of proton pump inhibitor (PPI) therapy if onset in patients less than 50 years of age and no alarm symptoms as listed in the urgent category
• Proton pump inhibitors should not be necessary long-term for dyspepsia, but may be necessary for severe and /or recurrent GORD, gastric protection for NSAIDs or Barrett's Oesophagus

For more information please see the HealthPathways Tasmania website.

GESA Guideline: Gastro- Oesophageal Reflux Disease (2011)* The test-and-treat strategy for H. pylori

(i.e. test and treat if positive) is a proven management strategy for patients with un-investigated dyspepsia who are under the age of 55 years and have no – alarm features" (bleeding, anaemia, early satiety, unexplained weight loss, progressive dysphagia, odynophagia, recurrent vomiting, family history of GI cancer, previous oesophageal-gastric malignancy)

Clinic appointments

? Red location flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Emergency

? Potentially life threatening symptoms suggestive of:

• acute upper GI tract bleeding
• acute severe lower GI tract bleeding
• oesophageal foreign bodies/food bolus
• bowel obstruction
• abdominal sepsis
• Acute Severe Colitis - see note

? Severe vomiting and/or diarrhoea with dehydration
? Acute/fulminant liver failure (to be referred to a centre with dedicated hepatology services
? Biliary sepsis (to be referred to a centre with ERCP service)

Note- Acute severe colitis as defined by the Truelove and Witts criteria - all patients with greater than or equal to 6 bloody bowel motions per 24 hours plus at least one of the following:

• temperature at presentation of over 37.8°C,
• pulse rate at presentation of over 90 bpm,
• haemoglobin at presentation of under 105 gm/l, CRP over 30mg/dl at presentation (or ESR over 30 mm/hr)

If you, or someone else, are experiencing a serious and life-threatening injury or illness call triple zero (000) immediately or go to the nearest Emergency Department.

Learn more about when to access emergency care and non-emergency care options if the injury or illness is not serious or life-threatening.

Urgent (Category 1)

Any patient with significant impact on activities of daily living, unexplained, persistent, or recent-onset symptoms (treatment-resistant) with any of the following concerning features select those that apply:

• Gastrointestinal bleeding
• Difficulty swallowing
• Persistent and/or recurrent vomiting
• Weight loss greater than or equal to 5% of body weight in previous 6 months
• Iron deficiency in males and postmenopausal women or unexplained iron deficiency in premenopausal women

We will endeavour to see these patients within four weeks

Urgent referrals should be accompanied by a phone call to the clinic and the relevant doctor for urgent assessment, or patient should be directed immediately to the Emergency Department.

Semi-urgent (Category 2)

Any patient with significant, unexplained, persistent, or recent-onset symptoms (treatment-resistant) without concerning features (as above).

Availability

North

Launceston General Hospital
Level 3 - Specialist Clinics

Phone: 1300 977 694
Fax: 03 6777 5227

North West

All North West referrals are managed via Mersey Community Hospital
Phone: 03 6478 5222
Fax: 03 6441 5942

South

Wellington Clinics (Level 10)
Phone: 03 6166 0000
Fax: 03 6234 3982