• Scottish Intercollegiate Guidelines Network (SIGN). Dyspepsia. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2003 Mar. 27 p. (SIGN publication; no. 68). [114 references]

Note from the Scottish Intercollegiate Guidelines Network (SIGN) and National Guideline Clearinghouse (NGC): In addition to these evidence-based recommendations, the guideline development group also identifies points of best clinical practice in the full-text guideline document.

The grades of recommendations (A-D) and levels of evidence (1++, 1+, 1-, 2++, 2+, 2-, 3, 4) are defined at the end of the "Major Recommendations" field.

Dyspepsia in the Community

The Role of the Community Pharmacist

D - Community pharmacists should advise patients suffering from dyspepsia associated with alarm symptoms to consult their general practitioner (see section 2.4, "Alarm Features and Risk of Cancer" of the original guideline document).

Symptoms of Dyspepsia

C - Symptom assessment cannot be relied upon to make a diagnosis of the cause of dyspepsia.

Alarm Features and Risk of Cancer

B - Patients with dyspepsia and alarm features should be referred to a hospital specialist for assessment.

(Note: There is no evidence to support the mandatory use of early upper gastrointestinal [GI] endoscopy to investigate patients over 55 years old who present with new onset uncomplicated dyspepsia.)

C - Upper GI endoscopy is the investigation of choice when further evaluation is warranted and should be widely available.

Management of Uncomplicated Dyspepsia

Patients Less Than 55 Years of Age

A - A non-invasive Helicobacter pylori test and treat strategy is as effective as endoscopy in the initial management of patients with uncomplicated dyspepsia who are less than 55 years old.

Patients Over 55 Years Old

C - A non-invasive H. pylori test and treat policy may be as appropriate as early endoscopy for the initial investigation and management of patients over the age of 55 years presenting with uncomplicated dyspepsia.

H. pylori Tests

B - The C urea breath test (CUBT) or faecal antigen tests are recommended for the pre-treatment diagnosis of H. pylori infection in the community. Less accurate, hospital-based serology tests have a place within the non-invasive test and treat strategy.

B - C urea breath test is the recommended test to determine whether H. pylori has been successfully eradicated.

Management of Functional Dyspepsia

Lifestyle Advice

(Note: There is no clear evidence to support a recommendation on the role of diet and lifestyle in the management of functional dyspepsia.)

Psychological Treatments

(Note: It is not possible to make a recommendation on the role of psychosocial interventions in the management of functional dyspepsia.)

Pharmacological Treatments

A - H. pylori eradication therapy should be considered in the management of functional dyspepsia.

B - A trial of acid suppression therapy may be considered in the management of functional dyspepsia.

(Note: In view of the problems with the quality of the trials involved, the value of prokinetic drugs is uncertain. It is not possible to make a recommendation on the role of prokinetics in the management of functional dyspepsia.)

(Note: It is not possible to make a recommendation on the role of cytoprotectives in the management of functional dyspepsia.)

(Note: It is not possible to make a recommendation on the role of antidepressants in the management of functional dyspepsia.)

Definitions

Grades of Recommendations

A - At least one meta-analysis, systematic review of randomised controlled trials (RCTs), or randomised controlled trial rated as 1++ and directly applicable to the target population; or

A body of evidence consisting principally of studies rated as 1+, directly applicable to the target population, and demonstrating overall consistency of results

B - A body of evidence including studies rated as 2++, directly applicable to the target population, and demonstrating overall consistency of results; or

Extrapolated evidence from studies rated as 1++ or 1+

C - A body of evidence including studies rated as 2+, directly applicable to the target population and demonstrating overall consistency of results; or

Extrapolated evidence from studies rate as 2++

D - Evidence level 3 or 4; or

Extrapolated evidence from studies rated as 2+

Levels of Evidence

1++ - High quality meta-analyses, systematic reviews of randomised controlled trials (RCTs), or RCTs with a very low risk of bias

1+ - Well-conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias

1- - Meta-analyses, systematic reviews, or RCTs with a high risk of bias

2++ - High quality systematic reviews of case control or cohort studies. High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal

2+ - Well-conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal

2- - Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal

3 - Non-analytic studies, e.g. case reports, case series

4 - Expert opinion

A clinical algorithm is provided for the investigation and management of dyspepsia.

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

• Scottish Intercollegiate Guidelines Network (SIGN). Dyspepsia. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2003 Mar. 27 p. (SIGN publication; no. 68). [114 references]

Not applicable: The guideline was not adapted from another source.

2003 Mar

Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]

Scottish Executive Health Department

Not stated

Guideline Development Group: Ms Angela Timoney (Chairman); Mr Colin MacKay (Secretary); Dr Robin Balfour; Mrs Janice Bancroft; Mr Graham Bell; Ms Anne Crozier; Dr Michael Gray; Dr Bob Heading; Mr Robin Harbour; Dr Stuart Hislop; Mrs Phoebe Isard; Ms Moira Kinnear; Professor Kenneth McColl; Dr John Murchison; Mr William R Murray; Dr Stephanie Morris; Mrs Fiona Phillips; Dr Rita Rigg; Dr Jack Taylor; Ms Joanne Topalian; Dr Craig Williams

All members of the Scottish Intercollegiate Guidelines Network (SIGN) guideline development groups are required to complete a declaration of interests, both personal and non-personal. A personal interest involves payment to the individual concerned, e.g., consultancies or other fee-paid work commissioned by or shareholdings in the pharmaceutical industry; a non-personal interest involves payment which benefits any group, unit or department for which the individual is responsible, e.g., endowed fellowships or other pharmaceutical industry support. SIGN guideline group members should be able to act as independently of external commercial influences as possible, therefore, individuals who declare considerable personal interests may be asked to withdraw from the group. Details of the declarations of interest of any guideline development group member(s) are available from the SIGN executive.

This summary was prepared by ECRI on November 20, 2003. The information was verified by the guideline developer on XX.