Gastroscopy and Gastro-oesophageal reflux

Author: Dr Charles Heatley, SCCG

Date Published: January 2018 (Revised)

Date to Review: January 2019

Description: Revised gastroscopy referral form is now attached.

The new pathway should help the decision making process in the event of considering a referral for direct access gastroscopy. Please refer to this prior to any referral. It is aimed at screening out low risk patients, bearing in mind that scoping a low risk patient may not change your management and carries a 1 in 3000 perforation risk.On the other hand it identifies patients at risk of early cancer following the 2015 NICE guidelines.

Should you decide to refer for gastroscopy please write a referral letter clearly stating your reason for referral and indicating clearly the investigation and management already undertaken , particularly use of PPI at full dose and HP testing. You can do this on a standard referral, or for ease there is a gastroscopy letter available on SytsmOne, search “open access gastroscopy”. A word version is also available for EMIS users.

Please remember that dysphagia, haematemesis and weight loss remain red flag symptoms.

There is a lot of patient info. Links are available on the pathway, along with NICE PPI therapy guidelines.

I would recommend Dr Kumar Basu’s article in Prescriber March 2016 for a GP update http://www.prescriber.co.uk/article/adult-gord-advances-and-challenges-in-management/

And I think the BMJ learning module for core medical trainees is good http://learning.bmj.com/learning/modules/elucidat/56e96a45cf94d.html?moduleId=10054662&status=LIVE&action=start&_flowId=ELU&sessionTimeoutInMin=90&locale=en_GB&shouldStartAtQuestionSection=false

CASES Educational Resources

Please take a few minutes to look or listen at the following video/podcast kindly made by Kumar Basu, consultant gastroenterologist, an update on gastro-oesophageal reflux and its management.

Video: https://youtu.be/vZtfSgtrLxA

Podcast: https://soundcloud.com/user-641355266/gastroesophageal-reflux-update-podcast

PPI Paper:

https://www.intranet.sheffieldccg.nhs.uk/Downloads/Medicines%20Management/prescribing%20guidelines/PPIs_risks_vs_benefits.pdf