1. FGBOU VPO MGMSU named after A. I. Evdokimov of the Ministry of Health of Russia (Moscow, Russia)
2. FGBOU VPO DVGMU of the Ministry of Health of Russia (Khavarovsk, Russia)
3. FGBOU VPO “Omsk State Medical University Ministry of Health of Russia” (Omsk, Russia)
4. Pirogov Russian National Research Medical University (RNRMU) (Moscow, Russia)
5. The Loginov Moscow Clinical Scientific Center (Moscow, Russia)
6. 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) (Krasnoyarsk, Russia)
7. FGBOU VO Voronezh State Medical University named after N. N. Burdenko (Voronezh, Russia)
8. Kazan State Medical University (Kazan, Russia)
9. Kazan (Volga region) Federal University (Kazan, Russia)
10. FGBOU VO IvGMA of the Ministry of Health of Russia (Ivanovo, Russia)
11. FGBOU VO “North-Western State Medical University n. a. I. I. Mechnikov” of the Ministry of Health of Russia (St. Petersburg, Russia)
12. GAUZ “Municipal Polyclinic № 6” (Ulan-Ude, Russia)
13. FGBOU VPO “Altai State Medical University” of the Ministry of Health of Russia (Barnaul, Russia)
14. GBU RS(Ya) “Yakutsk municipal hospital” (Yakutsk, Russia)
15. FGBOU VO “Ulyanovsk State University” (Ulyanovsk, Russia)
16. FGBOU VO “PIMU” of the Ministry of Health of Russia (Nizhny Novgorod, Russia)
17. Far Eastern State Medical University of the Ministry of Health of Russia (Khabarovsk, Russia)
18. Peoples’ Freindship University of Russia (PFU) (Moscow, Russia)
19. FGBOU VO “Bashkir State Medical University” of the Ministry of Health of Russia (Ufa, Russia)
20. Federal Research Center “Institute of Cytology and Genetics” of the Siberian Branch of the Russian Academy of Sciences (FRC ICG SB RAS) (Novosibirsk, Russia)
21. “Scientific research institute of Internal and Preventive Medicine” (SRI TPM) (Novosibirsk, Russia)
22. FGBOU VO “Smolensk State Medical University” of the Ministry of Health of Russia (Smolensk, Russia)
23. 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 (Belgorod, Russia)
24. Federal State Autonomous Educational Institution of Higher Education “Belgorod National Research University” (Belgorod, Russia)
25. FGBOU VO Siberian State Medical University (Tomsk, Russia)
26. 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 (Moscow, Russia)
27. FGBOU VO RostGMU of the Ministry of Health of Russia (Rostov on Don, Russia)
28. FGBOU VO RyazGMU (Ryazan, Russia)
29. FGBOU VO ChGMA of the Ministry of Health of Russia (Chita, Russia)
30. FGBOU VO Saratov State Medical University named after V. I. Razumovsky (Saratov, Russia)
31. GBUZ NO “The City Clinical Hospital No. 13” (Nizhny Novgorod, Russia)
32. FGBOU VO “Irkutsk State Medical University” of the Ministry of Health of Russia (Irkutsk, Russia)
33. KGBUZ DPO “Institute of advanced training of health professionals” MZKH (Khabarovsk, Russia)
34. GBUZ BUT they NOCB N. A. Semashko (Nizhny Novgorod, Russia)
35. Kuban State Medical University, Ministry of Health of the Russian Federation
36. FGBOU VO “Tver State Medical University” MH of Russia (Tver, Russia)
37. FGBOU VO PSMU of the Ministry of Health of Russia (Vladivostok, Russia)
38. Medical Center “MEDGARD”, the branch in Tolyatti (Tolyatty, Russia)
39. Multidisciplinary medicine center Bank of Russia (Moscow, Russia)
40. FGBOU VO Orenburg State Medical University of the Ministry of Health of Russia (Orenburg, Russia)
41. FGBOU VO Kemerovo State Medical University of the Ministry of Health of Russia (Kemerovo, Russia)
42. FGBOU VO NGMU of the Ministry of Health of Russia (Novosibirsk, Russia)
43. FGBOU VO Krasnoyarsk State Medical University named after prof. Voyno-Yasenetsky Ministry of Health of Russia (Krasnoyarsk, Russia)
44. IGMAPO- branch of the FGBOU DPO RMANPO of the Ministry of Health of Russia (Irkutsk, Russia)
45. PIUV — branch of FGBOU DPO RMANPO Ministry of health of the Russian Federation (Penza, Russia)
46. LTD “Zdorovje” (V. Novgorod, Russia)
47. Non-state health care institution “Separate Clinical Hospital at Barnaul Station” of the Open Joint-Stock Company Russian Railways (Barnaul, Russia)
48. FGBOU VO “StGMU of the Ministry of Health of Russia” (Stavropol, Russia)
49. KSMA — Branch Campus of the FSBEI of FPE “Russian Medical Academy of Continuing Professional Education” of the Ministry of Healthcare of the Russian Federation (Kazan, Russia)
50. FGBOU VO South-Ural State Medical University (Chelyabinsk, Russia)
51. FGBOU VO KGMU of the Ministry of Health of Russia (Kursk, Russia)
52. FGBOU VO Volgograd State Medical University (Volgograd, Russia)
53. Orel State University named after I. S. Turgenev (Orel, Russia)
54. FGBOU VO Federal State Budgetary Educational Institution of Higher Education “Kabardino-Balkarian State University named after H. M. Berbekov” (NalchiK, Russia)
55. GUZ Regional clinical hospital of the Ministry of Health of Russia (Chita, Russia)
56. LLS “University Clinic” (Arkhangelsk, Russia)
57. FGBOU VO “Astrakhan State Medical University of the Ministry of Health of Russia” (Astrakhan, Russia)
58. GBUZ DKKB MZ KK, Krasnodar Regional Base Medical College of the Ministry of Health of Russia (Krasnodar, Russia)
59. FGBOY VO Samara state medical university (SamGMU) of the Ministry of Health of Russia (Samara, Russia)
60. FGBVOU VO “Military Medical Academy named after S. M. Kirov” of the Ministry of Defence of the Russian Federation (Moscow, Russia)
61. National Medical Research Center for Preventive Medicine of the Ministry of Healthcare of the Russian Federation (Moscow, Russia)
62. E. A. Wagner Perm State Medical University (Perm, Russia)
63. FSBI “SCEEMP” of the Ministry of Health of the Russian Federation (Moscow, Russia)

Keywords:Dyspepsia, risk of cancer, diagnosis, management, primary care

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.

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Full text is published :
Lazebnik L.B., Alekseenko S.A., Lyalykova E.A., Samsonov A.A. et al. RECOMMENDATIONS ON MANAGEMENT OF PRIMARY CARE PATIENTS WITH SYMPTOMS OF DYSPEPSIA. Experimental and Clinical Gastroenterology Journal. 2018;153(05):04-18
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