As often happens, I found myself at guidelines.gov where I found the article "Gastrointestinal cancer. In: Suspected cancer in primary care: guidelines for investigation and referral" This article set forth the following guidelines for a primary care doctor's duty to respond to a patient with certain reflux symptoms.
The following symptoms should result in an Urgent Referral (within Two Weeks).
A person of any age with dyspepsia (reflux/indigestion) should be referred urgently for endoscopy or to a specialist if they have any of the following:
Dysphagia (trouble swallowing)
Progressive unexplained weight loss
Iron deficiency anaemia
A person aged 55 years or older with unexplained and persistent recent-onset dyspepsia solely, should be referred urgently for endoscopy.
A person with dysphagia (specifically, interference with the swallowing mechanism that occurs within 5 seconds of having commenced the swallowing process) should be referred urgently.
For a person with unexplained weight loss or iron deficiency anaemia, without dyspepsia, the possibility of upper gastrointestinal cancer and need for urgent referral for investigation should be considered.
For a person with persistent vomiting and weight loss, without dyspepsia, the possibility of upper gastrointestinal cancer and need for urgent referral for investigation should be considered.
For a person with unexplained worsening of their dyspepsia, the need for urgent referral to a specialist should be considered if they have any of the following known risk factors:
atrophic gastritis or
These are the standards for primary care practice at this time. Failure to adhere to these guidelines may amount to malpractice.
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