<unk>  has removed the H.pylori BLOOD test;  all H.pylori testing should be STOOL Antigen testing
Abdominal pain – do not refer chronic abdominal pain of unclear etiology to GI
Abnormal imaging
If radiology reading is clearly suspicious for malignancy, refer to GI
Do not refer patients with studies that “cannot rule out”, “includes possibility of”, etc.
Do not refer patients simply because radiology wrote “endoscopy is recommended” on final read.   Send patient to PMD or CCC for further interpretation of study results or further imaging
Anemia - Refer ONLY iron deficiency anemia; send Fe, TIBC, Ferritin; refer to TFU who will place e-consult if labs show iron deficiency
Barrett’s Esophagus – refer only if documented pathology report can be attached to e-consult
BRBPR
If patient is anemic, refer to GI
If patient is > 40yo, refer to GI
If patient is < 40yo, Anusol-HC supp qhs x 14 days. Symptoms persist? Follow-up PMD or have pt call TFU for GI referral
Do not refer if bloody diarrhea
Cirrhosis – Refer ONLY for banding of esophageal varices
Constipation – treat with osmotic laxative (e.g. sorbitol/miralax/prune juice) and send TSH if applicable
If severe (<1 BM per week) or rapid onset, refer to GI
Diarrhea
Will only see chronic non-infectious diarrhea >8 weeks; send C&S, O&P, C.diff, WBC; refer to TFU who will place e-consult if stool studies negative
Diverticulitis – do NOT refer to GI; Pt must be asymptomatic for 2 months before GI will consider colonoscopy
Dysphagia
If problem is high in throat region, refer to ENT instead If patient does not have weight loss, send barium swallow
If patient has weight loss or severe dysphagia, refer to GI
Dyspepsia (i.e. upper GI pain/epig pain >3 months)
If patient is > 55yo OR has worrisome symptoms, e.g., weight loss, refer to GI
If patient is < 55yo, order H. pylori test; refer to TFU who will treat with antibiotics if positive
If H.pylori test is negative or antibiotic trial fails, try PPI BID for at least 2 months. If that fails, refer to GI for evaluation
Family history of colon cancer (must be first-degree relative – mom,dad, sister, brother, child)
If only one relative, must be < 60 at age of diagnosis or if two or more relatives, age of diagnosis is not important
If patient fulfills above criteria and is either older than 40 or 10 years younger than the age of the relative at diagnosis (whichever is earlier), refer to GI
Otherwise, refer to primary care for fecal occult blood testing.
GERD (e.g. burning epig/chest pain with acid taste)
Do NOT refer to GI – pt must be on maximal therapy x 2months AND have lifestyle changes
If patient is not on maximum PPI therapy, change to or increase PPI to BID. Ex: Omeprazole 20 mg BID.
Hepatitis C - Do NOT refer to GI – treatment reserved for compensated cirrhotics; send to primary care
Inflammatory Bowel Disease
If urgent referral needed (moderate flare symptoms), call GI Fellow/Attending on-call; otherwise refer to PMD
Irritable Bowel Syndrome
Only if associated with worrisome symptoms (sudden onset at late age, weight loss), refer to GI
Occult positive stool only – do not refer from the ED
Pt must be >50yo, <50 BMI, AND have CLIA-approved lab occult-positive test NOT from ED to be referred
Polyps – Do NOT refer to GI unless you can attach endoscopy and pathology reports Ulcer – refer only GASTRIC ulcers that are >5mm; do NOT refer duodenal ulcers
If concern for malignancy based on outside endocscopy results, call GI for Urgent Consult
Urgent Consults
Communicate with on-call GI Fellow/Attending AND place e-consult; Note fellow on call CANNOT overbook a clinic visit
If radiology reading is clearly suspicious for malignancy, refer to GI
Do not refer patients with studies that “cannot rule out”, “includes possibility of”, etc.
Do not refer patients simply because radiology wrote “endoscopy is recommended” on final read.   Send patient to PMD or CCC for further interpretation of study results or further imaging
If patient is anemic, refer to GI
If patient is > 40yo, refer to GI
If patient is < 40yo, Anusol-HC supp qhs x 14 days. Symptoms persist? Follow-up PMD or have pt call TFU for GI referral
Do not refer if bloody diarrhea
If severe (<1 BM per week) or rapid onset, refer to GI
Will only see chronic non-infectious diarrhea >8 weeks; send C&S, O&P, C.diff, WBC; refer to TFU who will place e-consult if stool studies negative
If problem is high in throat region, refer to ENT instead If patient does not have weight loss, send barium swallow
If patient has weight loss or severe dysphagia, refer to GI
If patient is > 55yo OR has worrisome symptoms, e.g., weight loss, refer to GI
If patient is < 55yo, order H. pylori test; refer to TFU who will treat with antibiotics if positive
If H.pylori test is negative or antibiotic trial fails, try PPI BID for at least 2 months. If that fails, refer to GI for evaluation
If only one relative, must be < 60 at age of diagnosis or if two or more relatives, age of diagnosis is not important
If patient fulfills above criteria and is either older than 40 or 10 years younger than the age of the relative at diagnosis (whichever is earlier), refer to GI
Otherwise, refer to primary care for fecal occult blood testing.
Do NOT refer to GI – pt must be on maximal therapy x 2months AND have lifestyle changes
If patient is not on maximum PPI therapy, change to or increase PPI to BID. Ex: Omeprazole 20 mg BID.
If urgent referral needed (moderate flare symptoms), call GI Fellow/Attending on-call; otherwise refer to PMD
Only if associated with worrisome symptoms (sudden onset at late age, weight loss), refer to GI
Pt must be >50yo, <50 BMI, AND have CLIA-approved lab occult-positive test NOT from ED to be referred
If concern for malignancy based on outside endocscopy results, call GI for Urgent Consult
Communicate with on-call GI Fellow/Attending AND place e-consult; Note fellow on call CANNOT overbook a clinic visit
OVMC:ED
RRMC:ED
SCVMC:ED
SCVMC:EXC
SCVMC:Main
MHH-TMC
Tdap
Harbor Macros: AMA