Reflux/Heartburn/Dyspepsia

Availability

North South North West Statewide

Pre-referral work-up

History

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

  • Duration of symptoms
  • Severity and pattern of symptoms
  • Current and recently ceased medications especially failed treatments
  • Details of any previous endoscopies (date, result)
  • Smoking, alcohol and illicit drug use
  • Weight and BMI
  • Medications including any anticoagulants, NSAID, steroidal medication, iron, including reason for use
  • History of diabetes and its stability.
  • Please provide other information if present such as, morbid obesity, inability to read or understand English

Tests

Initial work up:

  • FBE and ESR
  • Iron studies
  • Consider depending on co-morbidities
    • LFT, Creatinine and electrolytes including eGFR,
    • Recent. INR
    • Recent HbA1C (to indicate stability of diabetes if present

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 Tasmanian Health Pathways website.

Emergency

Urgent / category 1

Semi-urgent / category 2

  • Onset of symptoms over 50 years of age
  • Failure to respond to PPI therapy
  • Worsening symptoms
  • Anaemia
  • Progressive, unintentional weight loss
  • Persistent vomiting

Routine / category 3

Onset of symptoms under 50 years of age with no alarm symptoms as listed in 'urgent' category

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

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)

Emergency:

Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED – Phone: (03) 6777 6405  Fax: (03) 6348 7382
MCH ED – Phone: (03) 6478 5120  Fax: (03) 6426 5115
NWRH ED – Phone: (03) 6493 6340  Fax: (03) 6430 6691
RHH ED - Phone: (03) 6166 6100  Fax: (03) 6222 8919

Urgent:

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:

We will endeavour to see these patients within 12 weeks

Routine:

Next available appointment