Investigations | Potential results | Clinical management plan |
---|---|---|
Actions from history, medication and dietary assessment | ||
History findings | Previous upper GI surgery |
|
Stress related |
| |
First line | ||
OGD | Inflammation/ulceration | See management of acid or bile related inflammation (p. 25). Lifestyle changes: reduce smoking, alcohol, chocolate, caffeine, fatty food, carbonated drinks, citrus. Assess weight and BMI. |
Malignancy/tumour recurrence | Discuss and refer urgently to the appropriate cancer MDT requesting an appointment within 2 weeks. | |
Pyloric stenosis (after upper GI surgery) | Consider dilatation (p. 25) with careful biopsy only after agreement from the appropriate MDT. | |
Barium swallow | Oesophageal stricture | See the guidance in tables 14 and 16. |
Delayed emptying |
| |
Oesophageal spasm |
| |
ECG/exercise test | Cardiac related | This is an emergency. Refer to cardiology. |
Second line | ||
Oesophageal manometry/pH/impedance studies | Spasm | Calcium antagonist. Low dose antidepressant, eg, citalopram. Refer to gastroenterology. |
Scleroderma |
| |
Third line | ||
If normal investigations/no response to intervention | Reassure. |
BMI, body mass index; GI, gastrointestinal; MDT, multidisciplinary team; OGD, upper GI endoscopy (oesophago-gastroduodenoscopy); PPI, proton pump inhibitor; SIBO, small intestinal bacterial overgrowth.