Table 26

Investigations	Potential results	Clinical management plan
Actions from history, medication and dietary assessment
History findings	Previous upper GI stent	Start simple analgesia. Refer to the pain team.
Medication findings	Bisphosphonates NSAID	Discuss alternative medication.
Dietary findings	Nutritional compromise	Refer for dietetic advice.
First line
OGD (do not biopsy obvious radiation change/ulceration)	Stricture	See the guidance in tables 14 and 16.
	Candidiasis	Antifungal therapy.
	Viral ulceration	Consider antiviral therapy, eg, Aciclovir for HSV. Ganciclovir for CMV.
	Radiotherapy induced ulceration	Pain control, eg, fentanyl patch. Regular mucaine/oxetacaine/sucralfate. PPI. Consider low dose of SSRI. Refer to the pain team. Refer for dietetic advice.
	Other causes of ulceration	Malignancy: refer to the appropriate MDT within 24 hours.
		Acid/bile reflux (p. 25).
Second line
Oesophageal manometry/pH/impedance studies	Spasm	Calcium antagonist. Low dose antidepressant, eg, citalopram. Refer to gastroenterology.
	Scleroderma	Start PPI or H2 antagonist. Refer to rheumatology.
Third line
If normal investigations/no response to intervention		Reassure.

CMV, cytomegalovirus; GI, gastrointestinal; H2, histamine receptor 2; HSV, herpes simplex virus; MDT, multidisciplinary team; NSAID, non-steroidal anti-inflammatory drug; OGD, upper GI endoscopy (oesophago-gastroduodenoscopy); PPI, proton pump inhibitor; SSRI, selective serotonin reuptake inhibitor.