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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)
