Table 26
InvestigationsPotential resultsClinical management plan
Actions from history, medication and dietary assessment
History findingsPrevious upper GI stentStart simple analgesia.
Refer to the pain team.
Medication findingsBisphosphonates
Discuss alternative medication.
Dietary findingsNutritional compromiseRefer for dietetic advice.
First line
(do not biopsy obvious radiation change/ulceration)
StrictureSee the guidance in tables 14 and 16.
CandidiasisAntifungal therapy.
Viral ulcerationConsider antiviral therapy, eg,
  • Aciclovir for HSV.

  • Ganciclovir for CMV.

Radiotherapy induced ulceration
  1. Pain control, eg, fentanyl patch.

  2. Regular mucaine/oxetacaine/sucralfate.

  3. PPI.

  4. Consider low dose of SSRI.

  5. Refer to the pain team.

  6. Refer for dietetic advice.

Other causes of ulcerationMalignancy: refer to the appropriate MDT within 24 hours.
Acid/bile reflux (p. 25).
Second line
Oesophageal manometry/pH/impedance studiesSpasmCalcium antagonist.
Low dose antidepressant, eg, citalopram.
Refer to gastroenterology.
  1. Start PPI or H2 antagonist.

  2. Refer to rheumatology.

Third line
If normal investigations/no response to interventionReassure.
  • 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.