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Version Date from Date to Amendment 
2.1 Nov 2017 Nov 2019 Removed RGH details 



Southern Adelaide Local Health Network (SALHN) 

  Consider non gastrointestinal causes (angina, pleuritic pain, musculoskeletal) 
  Predominant heartburn or acid regurgitation should be treated as gastro-oesophageal reflux disease and is not part 

of the definition of dyspepsia 
  Routine breath testing to confirm eradication of Helicobactor pylori is not required 


Information Required  
  Presence of Red flags 
  Drugs (NSAIDs) 
  Smoking and alcohol 
  Family history of upper gastrointestinal malignancy 

Investigations Required  
  FBE, EUC, LFTs, Amylase/lipase, CRP 

Fax Referrals to 
  Gastroenterology Outpatient Clinic 

Flinders Medical Centre 8204 5555 



Red Flags 
 Progressive dysphagia 

 Recurrent vomiting 
 Evidence of GI bleeding 


Suggested GP Management 
Patients ?55yrs without Red flag symptoms taking NSAIDs 
  Consider discontinuing NSAID or add acid suppression therapy with a 

proton pump inhibitor (PPI) 

Patients ?55yrs without Red flags not taking NSAIDs 
  The  test and treat  regimen is recommended: 
  H.pylori testing using the urea breath test or stool Ag test with subsequent 

eradication therapy in positive cases.  If pain persists, commence empirical 
PPI for 4 weeks 

  Those of whom are H.pylori negative should commence empirical PPI for 4-
8 weeks 


Indications for referral 
  Patient aged &gt;55yrs or presence of Red flag symptoms 
  Patient belongs to one of the above groups and pain is persistent despite 

the recommendations above  

When to assess for H.pylori eradication 
  H.pylori eradication rates approximate 80%. Whilst confirmation of 

eradication can be obtained by performing a urea breath ?four weeks after 
completion of therapy, confirmation of eradication is only indicated in the 
following circumstances*: 

  Patients have persistent dyspepsia following H.pylori eradication therapy 
  Patients who have had an H.pylori associated ulcer 
  Patients with gastric mucosal associated lymphoid tissue (MALT) lymphoma  
  Patients with a past history of gastric cancer 

Clinical Resources 
  American Gastroenterological 

Association Medical Position 
Statement: Evaluation of 
Dyspepsia. Gastroenterology. 

  Therapeutic Guidelines  

  Helicobacter pylori Reference: 
McColl, KE. Clinical Practice: 
Helicobacter pylori Infection. 
NEJM 2010; 362:1597 

Patient Information 
  Gastroenterological Society of 

Australia: information about 
Helicobacter Pylori.  

General Information to assist with referrals and the and Referral templates for FMC are available to download from the SAHN Outpatient Services 
website www.sahealth.sa.gov.au/SALHNoutpatients