At this point in the consultation, Dr Roberts has a choice to make. He could offer Dave some advice on lifestyle changes, based on the fact that many gastric problems discussed in primary care are lifestyle related, and a prescription for omeprazole (PPI).
Proton pump inhibitors (PPIs) reduce the production of acid by blocking the enzyme in the wall of the stomach that produces acid. Acid is necessary for the formation of most ulcers in the oesophagus, stomach, and duodenum, and the reduction of acid with
PPIs prevents ulcers and can allow any ulcers that exist to heal.
Dr Sarah Taylor, GatewayC GP Lead, explores some of the issues surrounding PPIs and diagnosing stomach cancer with Dr Was Mansoor, Consultant in Medical Oncology.
Key points
Stomach cancer is often diagnosed late as a result of prescribed PPIs masking or altering symptoms
Patients who have been prescribed proton pump inhibitors may:
No longer experience symptoms of indigestion
Have their red flag symptoms masked by increasing the dosage of PPIs
Experience a change in symptoms as a result of the PPI (i.e. change from a burning sensation to pain)
Results from the National Cancer Diagnosis Audit in 2018 found that stomach cancer has the highest percentage of avoidable delays (34%) out of all cancer sites.
Although Dave was not referred for a gastroscopy, it is a further option for patients who fit the criteria outlined below.
See the table below for NICE NG12 Guidance on when to offer or consider a gastrointestinal endoscopy.
Symptoms and specific features
Recommendation
Dyspepsiaorupper abdominal pain with weight loss, 55 and over
Offer urgent direct access upper gastrointestinal endoscopy (to be performed within 2 weeks) [1.2.7]
