Protocol № 1, Annex 1
President of the GSSR
MD, PhD, Professor Leonid Lazebnik

Adopted by
the XVI Congress of the Scientific Society of Gastroenterologists
St. Petersburg, May 16-18, 2018

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 fi rst 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, unspecifi ed). 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 modifi ed-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.

Key words: Dyspepsia, risk of cancer, diagnosis, management, primary care

The list of experts:  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 Т. 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.

For citation:: Lazebnik L. B., Alexeenko S. A., Lyalukova E. A., Samsonov A. A., Bordin D. S., et al. Recommendations on management of primary care patients with symptoms of dyspepsia. Experimental and Clinical Gastroenterology Journal. 2018;153(05):04–18.