Investigations | Potential results | Clinical management plan |
---|---|---|
Actions from history, medication and dietary assessment | ||
History findings | Aerophagia (excessive swallowing of air) | Eat slowly. Reduce chewing gum and temperature of hot drinks. |
Carbohydrate sensitivity | Assess for carbohydrate malabsorption (p. 26). Psychological support. | |
Medication findings | Use of effervescent medications | Discuss alternatives available. |
Sedatives, eg, temazepam | Discuss alternatives available. | |
Metformin | Change to long-acting preparation. | |
Dietary findings | Excessive use of carbonated drinks | Advise regarding reducing carbonated drinks intake. |
Eating/drinking too much in one sitting | Eat/drink little and often. | |
First line | ||
OGD and SI aspirate (p. 25) | Malignancy/tumour recurrence | Refer to appropriate MDT requesting an appointment within 2 weeks. |
SIBO | Management of SIBO (p. 27). | |
Stricture formation | Dilatation of anastomosis (p. 25)±dilatation of pylorus (if evidence of delayed gastric emptying) with careful biopsy. | |
Glucose hydrogen methane breath test | SIBO | Management of SIBO (p. 27). |
Second line | ||
If normal investigations/no response to intervention |
|
FODMAPs, fermentable oligo-di-monosaccharides and polyols; MDT, multidisciplinary team; OGD, upper GI endoscopy (oesophago-gastroduodenoscopy); SI, small intestine; SIBO, small intestinal bacterial overgrowth