Table 29

Investigation and management of resurgitation

Investigations	Potential results	Clinical management plan
Actions from history, medication and dietary assessment
History findings	History of (partial) gastrectomy or oesophagectomy	Small but frequent meals. Refer for dietetic advice. Consider starting prokinetic drugs. PPI/H2 antagonist±sucralfate.
	Rumination (regurgitation with no obvious cause)	Refer to gastroenterology. Consider referral to psychological support.
First line
OGD	Oesophageal stricture	See the guidance in tables 14 and 16.
	Malignancy/tumour recurrence	Refer to appropriate MDT requesting an appointment within 2 weeks.
Barium swallow	Pharyngeal pouch	Refer to ENT team.
	Oesophageal stricture	See the guidance in tables 14 and 16.
	Delayed emptying	Assess for SIBO (p. 21). Prokinetics (p. 26). Consider formal gastric emptying studies. Pyloric dilatation if after oesophagectomy.
	Oesophageal spasm/motility disorder	Start PPI or H2 antagonist. Calcium antagonist. Low dose antidepressant, eg, citalopram. Confirm with oesophageal manometry, pH/impedance studies. Refer to gastroenterology.
Second line
US/CT/MRI/PET	Malignancy/tumour recurrence/lymphadenopathy	Discuss and refer urgently to the appropriate cancer MDT requesting an appointment within 2 weeks.
	Consider also Internal hernia (if Roux-en-Y) Jejunal tube complication, eg, volvulus (if still in situ) Pancreatitis	These are emergencies. Refer to upper GI surgical team
	Mesenteric ischaemia	This is an emergency. Discuss with the on-call surgical team immediately.
	Ascites	Discuss with the supervising clinician and the oncology team within 24 hours.
Third line
If normal investigations/no response to intervention		Reassure.

ENT, ear, nose and throat; GI, gastrointestinal; H2, histamine receptor 2; MDT, multidisciplinary team; OGD, upper GI endoscopy (oesophago-gastroduodenoscopy); PET, positron emission tomography; PPI, proton pump inhibitor; SIBO, small intestinal bacterial overgrowth; US, ultrasound.