THE IMPACT OF DIRECT ACCESS ENDOSCOPY, HELICOBACTER-PYLORI NEAR PATIENT TESTING AND ACID SUPPRESSANTS ON THE MANAGEMENT OF DYSPEPSIA IN GENERAL-PRACTICE

Direct access endoscopy services, Helicobacter pylori infection and mo re effective acid suppression therapy have influenced the management o f dyspepsia in the past decade, Three hundred and ten GPs in south Lon don were surveyed via postal questionnaire to determine the impact of these factors on the management of dyspepsia in general practice. Nine ty-one per cent of GPs prescribed simple antacids as initial treatment for simple dyspepsia and referred only if symptoms did not improve. W hen acid suppresants were used, 41% used H-2 antagonists compared with 11% for proton pump inhibitors (p=0.0001). Risk factors for underlyin g malignancy were the most frequent reason for hospital referral at fi rst consultation. Long outpatient waiting times result in about 90% of GPs choosing direct access endoscopy as the route of referral for all patients with dyspepsia, while only 36% would refer patients with sin ister symptoms to direct access endoscopy if waiting times were simila r to that of outpatients. H. pylori near patient testing did not seem to influence the management of dyspepsia in general practice.