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The National Institute for Clinical Excellence (NICE) has recently
(June 2005) issued guidelines for suspected cancer referrals (1). These
are inconsistent with NICE’s 2004 guidelines for dyspepsia management (2).
Specifically, the dyspepsia management guideline states that routine
endoscopic investigation of patients with dyspepsia and without alarm
features is not necessary. A referral for endoscopy should be considered
in patients over 55 years old if dyspepsia persists despite helicobacter
pylori testing and despite acid suppressive therapy and there is at least
one of: a history of gastric ulcer or gastric surgery, a need for anti-
inflammatory medication, a raised risk of, or anxiety about, gastric
cancer (2).
The suspected cancer referral guideline more simply states that
patients over 55 years old with unexplained and persistent recent-onset
dyspepsia alone, need urgent endoscopy (within 2 weeks). Helicobacter
status should not influence this urgent referral (1).
Dyspespsia accounts for 4% of general practitioner consultations.
The conflicting statements in these two NICE documents is confusing to
general practitioners and endoscopy providers. NICE needs to resolve the
discrepancy urgently.
References
1. National Institute for Clinical Excellence. Referral guidelines
for suspected cancer. NICE Clinical Guideline No 27. London: NICE 2005.
2. National Institute for Clinical Excellence. Dyspepsia: managing
dyspepsia in primary care. NICE Clinical Guideline No 17. London: NICE
2004.
NICE Confusion
The National Institute for Clinical Excellence (NICE) has recently
(June 2005) issued guidelines for suspected cancer referrals (1). These
are inconsistent with NICE’s 2004 guidelines for dyspepsia management (2).
Specifically, the dyspepsia management guideline states that routine
endoscopic investigation of patients with dyspepsia and without alarm
features is not necessary. A referral for endoscopy should be considered
in patients over 55 years old if dyspepsia persists despite helicobacter
pylori testing and despite acid suppressive therapy and there is at least
one of: a history of gastric ulcer or gastric surgery, a need for anti-
inflammatory medication, a raised risk of, or anxiety about, gastric
cancer (2).
The suspected cancer referral guideline more simply states that
patients over 55 years old with unexplained and persistent recent-onset
dyspepsia alone, need urgent endoscopy (within 2 weeks). Helicobacter
status should not influence this urgent referral (1).
Dyspespsia accounts for 4% of general practitioner consultations.
The conflicting statements in these two NICE documents is confusing to
general practitioners and endoscopy providers. NICE needs to resolve the
discrepancy urgently.
References
1. National Institute for Clinical Excellence. Referral guidelines
for suspected cancer. NICE Clinical Guideline No 27. London: NICE 2005.
2. National Institute for Clinical Excellence. Dyspepsia: managing
dyspepsia in primary care. NICE Clinical Guideline No 17. London: NICE
2004.
Competing interests:
None declared
Competing interests: No competing interests