Effectiveness of Two Week Rule (TWR) Referral System for Patients with Symptoms of Dyspepsia

Category: Upper Gastrointestinal

Background: Based on Department of Health (DOH) guidelines to identify suspected upper gastrointestinal cancer cases, Performa is designed for General Practitioners (GP) to refer cases under TWR with symptoms of dyspepsia associated with “alarm symptoms“ (weight loss, vomiting, anaemia, family history of gastric cancer or age over 55 years).

Aims: To assess effectiveness of TWR patients with dyspepsia with alarm symptoms.

Methods: Patients referred by GPs in 2005 were studied. Data collected from Endoscribe. Patients were categorized TWR or non two week rule (NTWR). Both categories were analyzed for cancer.

Results: Total 658 patients were referred with dyspepsia and only 206 patients [TWR 126: NTWR 80] had dyspepsia with alarm symptoms. Mean age was 63 years [M: 44% F: 56%]. Cancer was detected in 2.91% [TWR: 3.17% (n=4): NTWR: 2.5% (n=2)]. In addition Barrett's oesophagus was 5.83% [TWR 5.56%(n=7): NTWR 6.25%(n=5)], Gastroesophageal reflux 14.56% [TWR 16%(n=20): NTWR 13%(n=10)] and PUD 10% [TWR 11% (n=11): NTWR 10%(n=9)].

Conclusions: The cancer detection under TWR in patients referred with symptoms of dyspepsia associated with alarm symptoms was (1:34) not in accordance to DOH guidelines. Appropriate referral and better assessment of symptoms of dyspepsia may improve the cancer detection rate.