The 2015 NICE guidelines 'Suspected cancer: recognition and referral' further updated the advice on who needs urgent referral for an endoscopy (i.e. within 2 weeks). The list below combines the advice for oesophageal and stomach cancer

Urgent

• All patients who've got dysphagia
• All patients who've got an upper abdominal mass consistent with stomach cancer
• Patients aged >= 55 years who've got weight loss , AND any of the following:
  • upper abdominal pain
  • reflux
  • dyspepsia

Non-urgent

• Patients with haematemesis
• Patients aged >= 55 years who've got:
  • treatment-resistant dyspepsia or
  • upper abdominal pain with low haemoglobin levels or
  • raised platelet count with any of the following: nausea, vomiting, weight loss, reflux, dyspepsia, upper abdominal pain
  • nausea or vomiting with any of the following: weight loss, reflux, dyspepsia, upper abdominal pain

Managing patients who do not meet referral criteria ('undiagnosed dyspepsia')

This can be summarised at a step-wise approach

• 1. Review medications for possible causes of dyspepsia
• 2. Lifestyle advice
• 3. Trial of full-dose proton pump inhibitor for one month OR a 'test and treat' approach for H. pylori
  • if symptoms persist after either of the above approaches then the alternative approach should be tried

Testing for H. pylori infection

• initial diagnosis: NICE recommend using a carbon-13 urea breath test or a stool antigen test, or laboratory-based serology 'where its performance has been locally validated'
• test of cure:
  • there is no need to check for H. pylori eradication if symptoms have resolved following test and treat
  • however, if repeat testing is required then a carbon-13 urea breath test should be used