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DYSPEPSIA

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

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DYSPEPSIA

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  1. DYSPEPSIA

  2. Dyspepsia Implies chronic • GORD • IBS • Ulcers • Gall Stones • Cancer • ‘Functional’

  3. 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

  4. Dyspepsia GORD • Heartburn • Waterbrash • Volume reflux • Response to PPIs • Dysphagia Diagnosis?? Management

  5. OSOPHAGITIS

  6. Laparoscopic Fundoplication Normal Subject

  7. Laparoscopic Fundoplication 24 hour trace of severe GOR

  8. Laparoscopic Fundoplication Interpretation of 24h tape of severe GOR

  9. Dyspepsia IBS • Abdominal pain - sites • Bloating • Distension • Variable bowel habit • Relation to stress How to talk to them!

  10. Dyspepsia Ulcers DUs - • Foregut • Nature of pain • The 3 best features of history … GUs …. The two big causes • Treatment • Remember NSAIDs

  11. Abdominal Pain 2002

  12. Dyspepsia Gall Stones • SEVERE foregut pain • duration • distribution • vomiting • recovery Other vague symptoms .......

  13. Dyspepsia Cancer • ‘New’ dyspepsia • Cancer age group • ‘Alarm’ symptoms • or signs • Dilemma Surgery?? Results??

  14. Common dyspeptic cancers • Oesophagus • Stomach • Pancreas • Liver mets 16

  15. * ENDOSCOPY STRICTURES *

  16. Dyspepsia ‘Functional’ • Upper abdominal pain • Investigations negative • Relation to food, stress • Vomiting unusual

  17. 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

  18. WHICH INVESTIGATION? • -INVESTIGATION • ENDOSCOPY • BARIUM SWALLOW • CT • MANOMETRY • OESOPHAGEAL Ph • PPI TEST • QUESTION • MUCOSA / THERAPEUTICS • ANATOMY / FUNCTION • MOTILITY • FUNCTION / REFLUX

  19. ACHALASIA DIAGNOSIS MANOMETRY - BARIUM

  20. DYSPEPSIA Implies chronic GORD IBS Ulcers Gall Stones Cancer ‘Functional’ Implies chronic GORD IBS Ulcers Gall Stones Cancer ‘Functional’ (Alcoholic gastropathy)

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