{"id":3192,"date":"2022-03-08T08:05:32","date_gmt":"2022-03-08T08:05:32","guid":{"rendered":"https:\/\/thepafp.org\/journal\/?post_type=abstract&p=3192"},"modified":"2022-03-08T08:50:05","modified_gmt":"2022-03-08T08:50:05","slug":"clinical-pathway-for-the-management-of-uninvestigated-dyspepsia-among-adults-in-family-and-community-practice-updated-2021","status":"publish","type":"abstract","link":"https:\/\/thepafp.org\/journal\/abstract\/clinical-pathway-for-the-management-of-uninvestigated-dyspepsia-among-adults-in-family-and-community-practice-updated-2021\/","title":{"rendered":"Clinical Pathway for the Management of Uninvestigated Dyspepsia among Adults in Family and Community Practice: Updated 2021"},"content":{"rendered":"

Clinical Pathway for the Management of Uninvestigated Dyspepsia among Adults in Family and Community Practice: Updated 2021<\/h2><\/div>

Nenacia Ranali Nirena P. Mendoza MD, FÂ鶹ֱ²¥, Noel M. Espallardo, MD, MSc, FÂ鶹ֱ²¥, Anna Guia O. Limpoco, MD, FÂ鶹ֱ²¥, Jane Efflyn Lardizabal-Bunyi, MD, FÂ鶹ֱ²¥, Abigael C. Andal-Saniano, MD, FÂ鶹ֱ²¥, Ma. Elinore Alba-Concha, MD, FÂ鶹ֱ²¥, Ma. Teresa Tricia G. Bautista, MD, FÂ鶹ֱ²¥ and Rhodora F. Pesebre, MD, FÂ鶹ֱ²¥<\/p>\n<\/div><\/div><\/div>

View Full Text<\/span><\/a><\/div><\/div><\/div><\/div><\/div>

Background<\/strong><\/p>\n

Uninvestigated dyspepsia is a common complaint in family practice in the Philippines.\u00a0 Patients usually seek consult due to severity of symptoms which affect their quality of life.\u00a0 The goals of management are short- and long-term symptom control, with reversal of possible underlying mechanisms, achievable through a combination of pharmacologic and non-pharmacologic interventions.<\/p>\n

Objective<\/strong><\/p>\n

The main objective of this pathway is to guide family physicians and primary care physicians in the assessment, diagnosis and management of adult patients with uninvestigated dyspepsia through a shared decision-making process.<\/p>\n

Method<\/strong><\/p>\n

This clinical pathway is an update of the Â鶹ֱ²¥\u2019s Clinical Pathways for the Management of Dyspepsia in Adults (2016).\u00a0 The current panel utilized the ADAPTE method and prioritized reviewing relevant clinical practice guidelines from 2017 to present. Grading of recommendation was achieved through a mixture of strength of available evidence and a consensus from a panel of experts.<\/p>\n

\u00a0<\/strong><\/p>\n

Summary of Recommendations<\/strong><\/p>\n

The main changes in the recommendations in this update are as follows: symptom-based classification of dyspepsia, screening for anxiety and depression, family and SCREEM assessment; initiation of therapeutic trial for most patients to whom H. pylori<\/em> testing is not available; extension of initial PPI treatment to 4-8 weeks, consideration of antacids\/alginates for immediate symptom relief, consideration of tricyclic antidepressants for non-responders to initial treatment; symptom-based non-pharmacologic advice, consideration of counseling and other psychosocial interventions; empowerment for self-treatment and as-needed therapy for those who have completed the initial treatment regimen.<\/p>\n

\u00a0<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
History and Physical Examination<\/em><\/strong><\/td>\n<\/tr>\n
1<\/td>\nObtain clinical history focusing on predominant symptoms and classify the patient into one of four symptom-based categories: ulcer-like, dysmotility-like, reflux-like, or unspecifed dyspepsia (A-II)<\/strong><\/td>\n<\/tr>\n
2<\/td>\nElicit alarm features (A-II)<\/strong><\/td>\n<\/tr>\n
3<\/td>\nDetermine use of medication such as NSAIDs, and lifestyle practices (A-II)<\/strong><\/td>\n<\/tr>\n
4<\/td>\nScreen for anxiety or depression (A-II)<\/strong><\/td>\n<\/tr>\n
5<\/td>\nDo Family and SCREEM assessment (A-III)<\/strong><\/td>\n<\/tr>\n
6<\/td>\nPerform a focused physical examination (general survey, BMI, abdominal and rectal exam, and pelvic exam for females (A-III)<\/strong><\/td>\n<\/tr>\n
Diagnostic Evaluation<\/em><\/strong><\/td>\n<\/tr>\n
7<\/td>\nRefer for prompt endoscopy with H. pylori testing if with combination of alarm features (A-I)<\/strong><\/td>\n<\/tr>\n
8<\/td>\nIf available, offer non-invasive H. Pylori<\/em> testing for patients with no alarm features (A-I)<\/strong><\/td>\n<\/tr>\n
9<\/td>\nOffer upper abdominal ultrasound, blood chemistry complete blood count, and\/or electrocardiogram if another organic problem\/s is\/are considered (A-II)<\/strong><\/td>\n<\/tr>\n
10<\/td>\nIf non-invasive H. Pylori test is not readily available, start empiric therapeutic trial (A-I)<\/strong><\/td>\n<\/tr>\n
11<\/td>\nOffer endoscopy if symptoms did not resolve after H. Pylori<\/em> eradication or 4-8 weeks after therapeutic trial (A-II)<\/strong><\/td>\n<\/tr>\n
12<\/td>\nOffer test and treat for H. pylori <\/em>if symptoms did not resolve after 4-8 weeks of therapeutic trial, with a 2-week wash off-period from PPI (A-II)<\/strong><\/td>\n<\/tr>\n
Pharmacologic Interventions<\/em><\/strong><\/td>\n<\/tr>\n
13<\/td>\nFor patients with ulcer- or reflux-like dyspepsia, offer proton-pump inhibitors for 4-8 weeks (A-I)<\/strong><\/td>\n<\/tr>\n
14<\/td>\nFor patients with dysmotility-like dyspepsia, offer a prokinetic for 1 week. PPI may be added and continued for 4-8 weeks. (A-I)<\/strong><\/td>\n<\/tr>\n
15<\/td>\nFor patients with unspecified dyspepsia, offer PPI for 4-8 weeks. Prokinetic may be added for 1 week. (A-I)<\/strong><\/td>\n<\/tr>\n
16<\/td>\nFor all symptom-based categories, offer antacids and\/or alginate as needed for immediate symptom relief (A-II)<\/strong><\/td>\n<\/tr>\n
17<\/td>\nStart H. pylori <\/em>eradication therapy if H. pylori<\/em> positive (A-I)<\/strong><\/td>\n<\/tr>\n
18<\/td>\nConsider H2-receptor antagonists for 2-4 weeks if with inadequate response to or unable to tolerate PPI (A-I)<\/strong><\/td>\n<\/tr>\n
19<\/td>\nIf unresponsive after 4-8 weeks of initial treatment, offer tricyclic antidepressants (A-I)<\/strong><\/td>\n<\/tr>\n
Non-pharmacologic Interventions<\/em><\/strong><\/td>\n<\/tr>\n
20<\/td>\nDiscuss with patient the risk factors, lifestyle modification and possible complications of dyspepsia (A-II)<\/strong><\/td>\n<\/tr>\n
21<\/td>\nExplain the dose, frequency, intended effect, possible side effects of medications, and importance of adherence (A-II)<\/strong><\/td>\n<\/tr>\n
22<\/td>\nDiscontinue or replace dyspepsia-causing medications (A-II)<\/strong><\/td>\n<\/tr>\n
23<\/td>\nOffer counselling if with psychosocial concerns (A-II)<\/strong><\/td>\n<\/tr>\n
24<\/td>\nElicit family members\u2019 lifestyle activities and offer modifications (A-III)<\/strong><\/td>\n<\/tr>\n
25<\/td>\nConsider community lifestyle activities (A-III)<\/strong><\/td>\n<\/tr>\n
Patient Outcomes<\/em><\/strong><\/td>\n<\/tr>\n
26<\/td>\nPatients must be educated about the diagnosis, its nature, risk factors and possible complications. The need to adhere to pharmacologic interventions, as well as lifestyle modifications must be emphasized.\u00a0 Control of symptoms, improvement of quality of life and functional status, and prevention of recurrence are the main therapeutic goals. (A-II)<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\u00a0<\/strong><\/p>\n

The complete recommendations per visit are outlined in Table 2.<\/p>\n

Dissemination and Implementation<\/strong><\/p>\n

This guideline shall be disseminated and implemented at the clinic and organizational level.\u00a0 It will be published in the \u201cThe Filipino Family Physician\u201d journal, social media platforms and will be disseminated through Â鶹ֱ²¥ local chapters, training institutions and during the national convention. Non-FCM primary care physicians will also be reached through relevant agencies. It shall be included in the references required during training activities and national exams of accredited training institutions, in coordination with the Â鶹ֱ²¥ committee on Residency Training. It shall be incorporated in checklists for compliance in audits and QA cycles, with support from the Â鶹ֱ²¥ committee on Quality Assurance and that on Standards for Family Practice.\u00a0 Feedback on utility and applicability will be actively sought from the intended users and other stakeholders.<\/p>\n<\/div><\/div><\/div><\/div><\/div><\/p>\n","protected":false},"featured_media":0,"template":"","meta":{"_acf_changed":false,"footnotes":""},"categories":[14,18],"tags":[16],"class_list":["post-3192","abstract","type-abstract","status-publish","hentry","category-abstract","category-abstract_2021_vol59_issue2","tag-abstract"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/thepafp.org\/journal\/wp-json\/wp\/v2\/abstract\/3192","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/thepafp.org\/journal\/wp-json\/wp\/v2\/abstract"}],"about":[{"href":"https:\/\/thepafp.org\/journal\/wp-json\/wp\/v2\/types\/abstract"}],"version-history":[{"count":3,"href":"https:\/\/thepafp.org\/journal\/wp-json\/wp\/v2\/abstract\/3192\/revisions"}],"predecessor-version":[{"id":3195,"href":"https:\/\/thepafp.org\/journal\/wp-json\/wp\/v2\/abstract\/3192\/revisions\/3195"}],"wp:attachment":[{"href":"https:\/\/thepafp.org\/journal\/wp-json\/wp\/v2\/media?parent=3192"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/thepafp.org\/journal\/wp-json\/wp\/v2\/categories?post=3192"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/thepafp.org\/journal\/wp-json\/wp\/v2\/tags?post=3192"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}