DYSPEPSIA

DyspepsiaImplies 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 FundoplicationNormal Subject

Laparoscopic Fundoplication24 hour trace of severe GOR

Laparoscopic FundoplicationInterpretation 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

UlcersDUs - • 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??

16

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• MUCOSA /

THERAPEUTICS

• ANATOMY / FUNCTION

• MOTILITY

• FUNCTION / REFLUX

-INVESTIGATION• ENDOSCOPY

• BARIUM SWALLOW• CT

• MANOMETRY

• OESOPHAGEAL Ph• PPI TEST

ACHALASIA DIAGNOSIS MANOMETRY - BARIUM

Implies chronicGORDIBSUlcersGall StonesCancer‘Functional’(Alcoholic gastropathy)

DYSPEPSIAImplies chronicGORDIBSUlcersGall StonesCancer‘Functional’