RECOMMENDATIONS ON MANAGEMENT OF PRIMARY CARE PATIENTS WITH SYMPTOMS OF DYSPEPSIA
Abstract
Aim: To develop evidence-based recommendations for primary care physicians and general practitioners (GP) on choosing the proper management tactics and making valuable & quick diagnostic decisions at outpatient phase for patients with symptoms of dyspepsia, and also reveal possible oncology on time. Summary of recommendations: Approximately 40% of the patients in Russia presenting to primary care with symptoms of dyspepsia. A doctor has to focus on the warning signs, which may require an urgent additional examination & the consultation with a surgeon/onco-surgeon or other specialists if required. With regard to a risk of cancer, a doctor should be more cautious in patients over 45 years of age. Early diagnosis of oncology depends mainly on cautiousness of GP, primary care physicians and their knowledge, future tactics with regard to the patients. From the mandatory diagnostic tests during the first visit, esophagogastroduodenoscopy and H. pylori diagnostics helps to exclude any organic esophagus and stomach pathology, possible oncology. While waiting for endoscopy results, a physician should use the preliminary diagnoses “Uninvestigated Dyspepsia” (ICD-10 К 31.9) (disease of stomach and duodenum, unspecified). After exclusion of all warning signs, therapy of dyspepsia should be in accordance to the order of the Ministry of Health No 248 which gives an option to use proton pump inhibitors (omeprazole or rabeprazole 20 mg daily) in combination with prokinetic (domperidone 30 mg daily). Fixed drug combination of omeprazole 20 mg and modified-release domperidone 30 mg/daily (Omez® DSR) is medically reasonable. Conclusion: The introduction of this recommendation into clinical practice will help clinicians to prevent diagnostic mistakes, unreasonable use of expensive diagnostic examinations and inappropriate treatment leads to improvement in the overall prognosis and quality of life for the patients.
About the Authors
L. B. Lazebnik
FGBOU VPO MGMSU named after A. I. Evdokimov of the Ministry of Health of Russia
Russian Federation
Russian Federation
S. A. Alexeenko
FGBOU VPO DVGMU of the Ministry of Health of Russia
Russian Federation
Russian Federation
E. A. Lyalukova
FGBOU VPO “Omsk State Medical University Ministry of Health of Russia”
Russian Federation
Russian Federation
A. A. Samsonov
Pirogov Russian National Research Medical University (RNRMU)
Russian Federation
Russian Federation
D. S. Bordin
The Loginov Moscow Clinical Scientific Center; FGBOU VO “Tver State Medical University” MH of Russia
Russian Federation
Russian Federation
V. V. Tsukanov
Federal Research Center “Krasnoyarsk Science Center” of the Siberian Branch of the Russian Academy of Sciences, “Scientific research institute of medical problems of the North” (FRC KSC SB RAS, SRI MPN)
Russian Federation
Russian Federation
N. Yu. Alekseev
FGBOU VO Voronezh State Medical University named after N. N. Burdenko
Russian Federation
Russian Federation
R. A. Abdulkhakov
Kazan State Medical University
Russian Federation
Russian Federation
S. R. Abdulkhakov
Kazan State Medical University; Kazan (Volga region) Federal University
Russian Federation
Russian Federation
O. B. Arkin
FGBOU VO IvGMA of the Ministry of Health of Russia
Russian Federation
Russian Federation
V. A. Akhmedov
FGBOU VPO “Omsk State Medical University Ministry of Health of Russia”
Russian Federation
Russian Federation
I. G. Bakulin
FGBOU VO “North-Western State Medical University n. a. I. I. Mechnikov” of the Ministry of Health of Russia
Russian Federation
Russian Federation
N. V. Bakulina
FGBOU VO “North-Western State Medical University n. a. I. I. Mechnikov” of the Ministry of Health of Russia
Russian Federation
Russian Federation
R. G. Bashaeva
GAUZ “Municipal Polyclinic № 6”
Russian Federation
Russian Federation
G. A. Batischeva
FGBOU VO Voronezh State Medical University named after N. N. Burdenko
Russian Federation
Russian Federation
I. I. Belova
FGBOU VPO “Altai State Medical University” of the Ministry of Health of Russia
Russian Federation
Russian Federation
N. N. Vasilyev
GBU RS(Ya) “Yakutsk municipal hospital”
Russian Federation
Russian Federation
M. A. Vise-Khripunova
FGBOU VO “Ulyanovsk State University”
Russian Federation
Russian Federation
T. V. Vlasova
FGBOU VO “PIMU” of the Ministry of Health of Russia
Russian Federation
Russian Federation
N. V. Voronina
Far Eastern State Medical University of the Ministry of Health of Russia
Russian Federation
Russian Federation
E. S. Vyuchnova
FGBOU VPO MGMSU named after A. I. Evdokimov of the Ministry of Health of Russia
Russian Federation
Russian Federation
S. S. Vyalov
Peoples’ Freindship University of Russia (PFU)
Russian Federation
Russian Federation
Z. F. Gimaeva
FGBOU VO “Bashkir State Medical University” of the Ministry of Health of Russia
Russian Federation
Russian Federation
E. V. Golovanova
FGBOU VPO MGMSU named after A. I. Evdokimov of the Ministry of Health of Russia
Russian Federation
Russian Federation
L. S. Grebeneva
LLC “Dr. Reddy’s Laboratories”
Russian Federation
Russian Federation
I. N. Grigorieva
Federal Research Center “Institute of Cytology and Genetics” of the Siberian Branch of the Russian Academy of Sciences (FRC ICG SB RAS); “Scientific research institute of Internal and Preventive Medicine” (SRI TPM)
Russian Federation
Russian Federation
N. N. Dekhnich
FGBOU VO “Smolensk State Medical University” of the Ministry of Health of Russia
Russian Federation
Russian Federation
T. V. Dmitrieva
Office No. 10 PKU “Main Bureau of medical-social examination of the Belgorod region” The Ministry of labour and social protection of the Russian Federation; Federal State Autonomous Educational Institution of Higher Education “Belgorod National Research University”
Russian Federation
Russian Federation
I. V. Dolgalev
FGBOU VO Siberian State Medical University
Russian Federation
Russian Federation
V. N. Drozdov
FGAOU VO Federal State Autonomous Educational Institution of Higher Education I. M. Sechenov First Moscow State Medical University of the Ministry of Health of Russian Federation
Russian Federation
Russian Federation
L. I. Dyatchina
FGBOU VO RostGMU of the Ministry of Health of Russia
Russian Federation
Russian Federation
T. V. Zhestkova
FGBOU VO RyazGMU
Russian Federation
Russian Federation
A. A. Zhilina
FGBOU VO ChGMA of the Ministry of Health of Russia
Russian Federation
Russian Federation
E. V. Kazakova
FGBOU VPO DVGMU of the Ministry of Health of Russia
Russian Federation
Russian Federation
E. N. Kareva
Pirogov Russian National Research Medical University (RNRMU); FGAOU VO Federal State Autonomous Educational Institution of Higher Education I. M. Sechenov First Moscow State Medical University of the Ministry of Health of Russian Federation
Russian Federation
Russian Federation
E. I. Kashkina
FGBOU VO Saratov State Medical University named after V. I. Razumovsky
Russian Federation
Russian Federation
E. A. Kizova
GBUZ NO “The City Clinical Hospital No. 13”
Russian Federation
Russian Federation
I. V. Kozlova
FGBOU VO Saratov State Medical University named after V. I. Razumovsky
Russian Federation
Russian Federation
N. M. Kozlova
FGBOU VO “Irkutsk State Medical University” of the Ministry of Health of Russia
Russian Federation
Russian Federation
S. M. Kolesnikova
KGBUZ DPO “Institute of advanced training of health professionals” MZKH
Russian Federation
Russian Federation
E. N. Kolodey
GBUZ BUT they NOCB N. A. Semashko
Russian Federation
Russian Federation
O. G. Kompaniets
Kuban State Medical University, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
A. G. Kononova
FGBOU VO “Tver State Medical University” MH of Russia
Russian Federation
Russian Federation
N. A. Konyshko
FGBOU VO “Smolensk State Medical University” of the Ministry of Health of Russia
Russian Federation
Russian Federation
N. V. Korochanskaya
Kuban State Medical University, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
N. V. Kulakova
FGBOU VO PSMU of the Ministry of Health of Russia
Russian Federation
Russian Federation
D. O. Kurguzova
FGAOU VO Federal State Autonomous Educational Institution of Higher Education I. M. Sechenov First Moscow State Medical University of the Ministry of Health of Russian Federation
Russian Federation
Russian Federation
E. D. Lapina
Medical Center “MEDGARD”, the branch in Tolyatti
Russian Federation
Russian Federation
E. D. Lee
Multidisciplinary medicine center Bank of Russia
Russian Federation
Russian Federation
E. V. Luzina
FGBOU VO ChGMA of the Ministry of Health of Russia
Russian Federation
Russian Federation
O. V. Mironchev
FGBOU VO Orenburg State Medical University of the Ministry of Health of Russia
Russian Federation
Russian Federation
K. B. Mozes
FGBOU VO Kemerovo State Medical University of the Ministry of Health of Russia
Russian Federation
Russian Federation
M. V. Mokshina
FGBOU VO PSMU of the Ministry of Health of Russia
Russian Federation
Russian Federation
O. A. Mubarakshina
FGBOU VO Voronezh State Medical University named after N. N. Burdenko
Russian Federation
Russian Federation
V. A. Nevzorova
FGBOU VO PSMU of the Ministry of Health of Russia
Russian Federation
Russian Federation
D. L. Nepomnyashchikh
FGBOU VO NGMU of the Ministry of Health of Russia
Russian Federation
Russian Federation
N. N. Nikolaeva
FGBOU VO Krasnoyarsk State Medical University named after prof. Voyno-Yasenetsky Ministry of Health of Russia
Russian Federation
Russian Federation
E. V. Onuchina
IGMAPO- branch of the FGBOU DPO RMANPO of the Ministry of Health of Russia
Russian Federation
Russian Federation
E. N. Otteva
KGBUZ DPO “Institute of advanced training of health professionals” MZKH
Russian Federation
Russian Federation
E. S. Panina
PIUV - branch of FGBOU DPO RMANPO Ministry of health of the Russian Federation
Russian Federation
Russian Federation
I. G. Pakhomova
Peoples’ Freindship University of Russia (PFU)
Russian Federation
Russian Federation
M. M. Petrova
FGBOU VO Krasnoyarsk State Medical University named after prof. Voyno-Yasenetsky Ministry of Health of Russia
Russian Federation
Russian Federation
I. L. Petrunko
IGMAPO- branch of the FGBOU DPO RMANPO of the Ministry of Health of Russia
Russian Federation
Russian Federation
S. G. Peshekhonov
LTD “Zdorovje”
Russian Federation
Russian Federation
M. A. Pleshkova
Kuban State Medical University, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
I. A. Podyapolskaya
Non-state health care institution “Separate Clinical Hospital at Barnaul Station” of the Open Joint-Stock Company Russian Railways
Russian Federation
Russian Federation
O. Yu. Pozdnyakova
FGBOU VO “StGMU of the Ministry of Health of Russia”
Russian Federation
Russian Federation
I. B. Ponomareva
FGBOU VO RyazGMU
Russian Federation
Russian Federation
I. V. Putintseva
FGBOU VO Krasnoyarsk State Medical University named after prof. Voyno-Yasenetsky Ministry of Health of Russia
Russian Federation
Russian Federation
O. V. Ryzhkova
FGBOU VO “Irkutsk State Medical University” of the Ministry of Health of Russia
Russian Federation
Russian Federation
R. G. Saifutdinov
KSMA - Branch Campus of the FSBEI of FPE “Russian Medical Academy of Continuing Professional Education” of the Ministry of Healthcare of the Russian Federation
Russian Federation
Russian Federation
A. S. Sarsenbaeva
FGBOU VO South-Ural State Medical University
Russian Federation
Russian Federation
T. N. Sviridova
FGBOU VO Voronezh State Medical University named after N. N. Burdenko
Russian Federation
Russian Federation
G. B. Selivanova
Pirogov Russian National Research Medical University (RNRMU)
Russian Federation
Russian Federation
S. Yu. Serebrova
FGAOU VO Federal State Autonomous Educational Institution of Higher Education I. M. Sechenov First Moscow State Medical University of the Ministry of Health of Russian Federation; FSBI “SCEEMP” of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
L. G. Smolkova
FGBOU VO “Irkutsk State Medical University” of the Ministry of Health of Russia
Russian Federation
Russian Federation
A. K. Starodubtsev
FGAOU VO Federal State Autonomous Educational Institution of Higher Education I. M. Sechenov First Moscow State Medical University of the Ministry of Health of Russian Federation
Russian Federation
Russian Federation
A. A. Stepchenko
FGBOU VO KGMU of the Ministry of Health of Russia
Russian Federation
Russian Federation
O. V. Stefaniuk
FGBOU VPO MGMSU named after A. I. Evdokimov of the Ministry of Health of Russia; National Medical Research Center for Preventive Medicine of the Ministry of Healthcare of the Russian Federation
Russian Federation
Russian Federation
G. N. Tarasova
FGBOU VO RostGMU of the Ministry of Health of Russia
Russian Federation
Russian Federation
E. A. Tomina
FGBOU VO ChGMA of the Ministry of Health of Russia
Russian Federation
Russian Federation
S. V. Turkina
FGBOU VO Volgograd State Medical University
Russian Federation
Russian Federation
M. S. Turchina
Orel State University named after I. S. Turgenev
Russian Federation
Russian Federation
M. A. Umetov
FGBOU VO Federal State Budgetary Educational Institution of Higher Education “Kabardino-Balkarian State University named after H. M. Berbekov”
Russian Federation
Russian Federation
O. V. Fedorishina
IGMAPO- branch of the FGBOU DPO RMANPO of the Ministry of Health of Russia
Russian Federation
Russian Federation
L. V. Fedorova
GUZ Regional clinical hospital of the Ministry of Health of Russia
Russian Federation
Russian Federation
J. A. Khabarova
LLS “University Clinic”
Russian Federation
Russian Federation
I. I. Khamnagadaev
Federal State Autonomous Educational Institution of Higher Education “Belgorod National Research University”
Russian Federation
Russian Federation
O. V. Khlynova
E. A. Wagner Perm State Medical University
Russian Federation
Russian Federation
I. G. Khripunova
FGBOU VO “StGMU of the Ministry of Health of Russia”
Russian Federation
Russian Federation
E. N. Chernysheva
FGBOU VO “Astrakhan State Medical University of the Ministry of Health of Russia”
Russian Federation
Russian Federation
N. S. Shatokhina
GBUZ DKKB MZ KK, Krasnodar Regional Base Medical College of the Ministry of Health of Russia
Russian Federation
Russian Federation
M. A. Shevyakov
FGBOU VO “North-Western State Medical University n. a. I. I. Mechnikov” of the Ministry of Health of Russia
Russian Federation
Russian Federation
M. G. Shpuntov
FGBOU VO “Smolensk State Medical University” of the Ministry of Health of Russia
Russian Federation
Russian Federation
I. N. Yurchenko
FGBOY VO Samara state medical university (SamGMU) of the Ministry of Health of Russia
Russian Federation
Russian Federation
A. A. Yakovlev
FGBOU VO RostGMU of the Ministry of Health of Russia
Russian Federation
Russian Federation
O. V. Yacob
FGBVOU VO “Military Medical Academy named after S. M. Kirov” of the Ministry of Defence of the Russian Federation
Russian Federation
Russian Federation
T. N. Yankovaya
FGBOU VO “Smolensk State Medical University” of the Ministry of Health of Russia
Russian Federation
Russian Federation
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Review
For citations:
Lazebnik L.B., Alexeenko S.A., Lyalukova E.A., Samsonov A.A., Bordin D.S., Tsukanov V.V., Alekseev N.Yu., Abdulkhakov R.A., Abdulkhakov S.R., Arkin O.B., Akhmedov V.A., Bakulin I.G., Bakulina N.V., Bashaeva R.G., Batischeva G.A., Belova I.I., Vasilyev N.N., Vise-Khripunova M.A., Vlasova T.V., Voronina N.V., Vyuchnova E.S., Vyalov S.S., Gimaeva Z.F., Golovanova E.V., Grebeneva L.S., Grigorieva I.N., Dekhnich N.N., Dmitrieva T.V., Dolgalev I.V., Drozdov V.N., Dyatchina L.I., Zhestkova T.V., Zhilina A.A., Kazakova E.V., Kareva E.N., Kashkina E.I., Kizova E.A., Kozlova I.V., Kozlova N.M., Kolesnikova S.M., Kolodey E.N., Kompaniets O.G., Kononova A.G., Konyshko N.A., Korochanskaya N.V., Kulakova N.V., Kurguzova D.O., Lapina E.D., Lee E.D., Luzina E.V., Mironchev O.V., Mozes K.B., Mokshina M.V., Mubarakshina O.A., Nevzorova V.A., Nepomnyashchikh D.L., Nikolaeva N.N., Onuchina E.V., Otteva E.N., Panina E.S., Pakhomova I.G., Petrova M.M., Petrunko I.L., Peshekhonov S.G., Pleshkova M.A., Podyapolskaya I.A., Pozdnyakova O.Yu., Ponomareva I.B., Putintseva I.V., Ryzhkova O.V., Saifutdinov R.G., Sarsenbaeva A.S., Sviridova T.N., Selivanova G.B., Serebrova S.Yu., Smolkova L.G., Starodubtsev A.K., Stepchenko A.A., Stefaniuk O.V., Tarasova G.N., Tomina E.A., Turkina S.V., Turchina M.S., Umetov M.A., Fedorishina O.V., Fedorova L.V., Khabarova J.A., Khamnagadaev I.I., Khlynova O.V., Khripunova I.G., Chernysheva E.N., Shatokhina N.S., Shevyakov M.A., Shpuntov M.G., Yurchenko I.N., Yakovlev A.A., Yacob O.V., Yankovaya T.N. RECOMMENDATIONS ON MANAGEMENT OF PRIMARY CARE PATIENTS WITH SYMPTOMS OF DYSPEPSIA. Experimental and Clinical Gastroenterology. 2018;(5):4-18. (In Russ.)
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