Reflux/Heartburn/Dyspepsia
Outpatients | GastroenterologyThis 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