Table 29

Investigation and management of resurgitation

InvestigationsPotential resultsClinical management plan
Actions from history, medication and dietary assessment
History findingsHistory of (partial) gastrectomy or oesophagectomy
  1. Small but frequent meals.

  2. Refer for dietetic advice.

  3. Consider starting prokinetic drugs.

  4. PPI/H2 antagonist±sucralfate.

Rumination (regurgitation with no obvious cause)
  1. Refer to gastroenterology.

  2. Consider referral to psychological support.

First line
OGDOesophageal strictureSee the guidance in tables 14 and 16.
Malignancy/tumour recurrenceRefer to appropriate MDT requesting an appointment within 2 weeks.
Barium swallowPharyngeal pouchRefer to ENT team.
Oesophageal strictureSee the guidance in tables 14 and 16.
Delayed emptying
  1. Assess for SIBO (p. 21).

  2. Prokinetics (p. 26).

  3. Consider formal gastric emptying studies.

  4. Pyloric dilatation if after oesophagectomy.

Oesophageal spasm/motility disorder
  1. Start PPI or H2 antagonist.

  2. Calcium antagonist.

  3. Low dose antidepressant, eg, citalopram.

  4. Confirm with oesophageal manometry, pH/impedance studies.

  5. Refer to gastroenterology.

Second line
US/CT/MRI/PETMalignancy/tumour recurrence/lymphadenopathyDiscuss and refer urgently to the appropriate cancer MDT requesting an appointment within 2 weeks.
Consider also
  1. Internal hernia (if Roux-en-Y)

  2. Jejunal tube complication, eg, volvulus (if still in situ)

  3. Pancreatitis

These are emergencies. Refer to upper GI surgical team
Mesenteric ischaemiaThis is an emergency. Discuss with the on-call surgical team immediately.
AscitesDiscuss with the supervising clinician and the oncology team within 24 hours.
Third line
If normal investigations/no response to interventionReassure.
  • 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.