Table 17

Investigation and management of early satiety

Investigations	Potential results	Clinical management plan
Actions from history, medication and dietary assessment
History findings	After gastrectomy or oesophagectomy	Reassure in the postoperative period. Refer for dietetic advice.
	History of diabetes and high blood sugar levels	Refer the patient to the GP for further management. Refer for dietetic advice.
	Constipation	See management of constipation (p. 26).
Medication findings	Anticholinergic drugs	Discuss potential alternatives.
First line
OGD and SI aspirate (p. 25)	SIBO	Management of SIBO (p. 27).
OGD and SI aspirate (p. 25)	Malignancy/tumour recurrence	Discuss and refer to appropriate MDT requesting an appointment within 2 weeks.
	Biliary gastritis	See management of bile related inflammation (p. 25).
	Delayed gastric emptying	Consider gastric emptying studies. Assess for SIBO Consider prokinetics (p. 26). Pyloric dilatation if after oesophagectomy. Referral to dietitian.
	Pyloric spasm/stricture	Consider dilatation (p. 25) with careful biopsy only after agreement from the appropriate MDT.
Glucose hydrogen methane breath test	SIBO	Management of SIBO (p. 27).
CT chest, abdomen, pelvis	Malignancy/tumour recurrence	Discuss and refer urgently to the appropriate cancer MDT requesting an appointment within 2 weeks.
Routine blood tests	Abnormal results	Follow treatment for abnormal blood results (p. 2).
Second line
Barium meal	Pyloric spasm/stricture	Consider dilatation (p. 25) with careful biopsy only after agreement from the appropriate MDT.
Third line
Gastric emptying study	Delayed gastric emptying	Assess for SIBO. Consider prokinetic (p. 26). Pyloric dilatation if after oesophagectomy. Referral to dietitian.
Fourth line
If normal investigations/no response to intervention		Reassure.

CT, computerised tomography; GP, general practitioner; MDT, multidisciplinary team; OGD, upper GI endoscopy (oesophago-gastroduodenoscopy); SI, small intestine; SIBO, small intestinal bacterial overgrowth.