Dyspepsia on long-term PPI requesting a repeat script — CCE clinical encounter

Objectives

1. Elicit the alarm feature (intermittent dysphagia) that converts a script renewal into an urgent endoscopy referral. ^[2]
2. Explain why four years of unreviewed PPI without testing is under-investigation, not good care. ^[1]
3. Plan the H. pylori test-and-treat pathway including the two-week PPI washout. ^[1]
4. Counsel honestly about rebound acid hypersecretion so tapering does not fail on a misunderstanding. ^[3]
5. Address the dementia fear with proportionate, evidence-based reassurance without dismissing her concern. ^[3]

15-minute encounter with a role-player; 5 minutes reading time. She wants a quick script and is mildly irritated by questions; your task is to surface the dysphagia she has not volunteered as urgent, restructure her management, and leave her with a plan she accepts. ^{[2] [3]}