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DYSPEPSIA
Dyspepsia
Implies chronic
• GORD
• IBS
• Ulcers
• Gall Stones
• Cancer
• ‘Functional’
Dyspepsia
Perspective
• 10% of all GP consultations
• 9,000 endoscopies per year at Walsgrave,
waiting time up to 9 months
• Pragmatism in treatment and algorrhythms
Dyspepsia
GORD
• Heartburn
• Waterbrash
• Volume reflux
• Response to PPIs
• Dysphagia
Diagnosis??
Management
OSOPHAGITIS
Laparoscopic Fundoplication
Normal Subject
Laparoscopic Fundoplication
24 hour trace of severe GOR
Laparoscopic Fundoplication
Interpretation of 24h tape of severe GOR
Dyspepsia
IBS
• Abdominal pain - sites
• Bloating
• Distension
• Variable bowel habit
• Relation to stress
How to talk to them!
Dyspepsia
Ulcers
DUs • Foregut
• Nature of pain
• The 3 best features of history …
GUs ….
The two big causes
• Treatment
• Remember NSAIDs
Abdominal Pain 2002
Dyspepsia
Gall Stones
• SEVERE foregut pain
• duration
• distribution
• vomiting
• recovery
Other vague symptoms .......
Dyspepsia
Cancer
• ‘New’ dyspepsia
• Cancer age group
• ‘Alarm’ symptoms
• or signs
• Dilemma
Surgery?? Results??
Common dyspeptic cancers
•
•
•
•
Oesophagus
Stomach
Pancreas
Liver mets
16
* ENDOSCOPY STRICTURES *
Dyspepsia
‘Functional’
• Upper abdominal pain
• Investigations negative
• Relation to food, stress
• Vomiting unusual
Investigation
(The conventional sequence)
But really what is the question
• Cancer?? Or reassurance
• Cause of dyspepsia
• Helicobacter status
• Does it really matter?? - answer
Or just treat and see??
• What conditions not
WHICH INVESTIGATION?
– QUESTION
-INVESTIGATION
• MUCOSA /
THERAPEUTICS
• ENDOSCOPY
• ANATOMY /
FUNCTION
• BARIUM SWALLOW
• CT
• MOTILITY
• FUNCTION / REFLUX
• MANOMETRY
• OESOPHAGEAL Ph
• PPI TEST
ACHALASIA DIAGNOSIS
MANOMETRY - BARIUM
DYSPEPSIA
Implies chronic
GORD
IBS
Implies chronic
Ulcers
GORD
Gall
Stones
IBS
Cancer
Ulcers
‘Functional’
Gall Stones
Cancer
‘Functional’
(Alcoholic gastropathy)