Dyspepsia

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DYSPEPSIA
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Dyspepsia

• Implies chronic
• GORD
• IBS
• Ulcers
• Gall Stones
• Cancer
• Functional

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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

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Dyspepsia

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

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OSOPHAGITIS
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Laparoscopic Fundoplication

• Normal Subject

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Laparoscopic Fundoplication

• 24 hour trace of severe GOR

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Laparoscopic Fundoplication

• Interpretation of 24h tape of severe GOR

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Dyspepsia

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

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Dyspepsia

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

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Abdominal Pain 2002
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Dyspepsia

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

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Dyspepsia

• Cancer
• New dyspepsia
• Cancer age group
• Alarm symptoms
• or signs
• Dilemma
• Surgery?? Results??

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Common dyspeptic cancers

• Oesophagus
• Stomach
• Pancreas
• Liver mets

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ENDOSCOPY STRICTURES
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Dyspepsia

• Functional
• Upper abdominal pain
• Investigations negative
• Relation to food, stress
• Vomiting unusual

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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

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WHICH INVESTIGATION?

• -INVESTIGATION
• ENDOSCOPY
• BARIUM SWALLOW
• CT
• MANOMETRY
• OESOPHAGEAL Ph
• PPI TEST

• QUESTION
• MUCOSA / THERAPEUTICS
• ANATOMY / FUNCTION
• MOTILITY
• FUNCTION / REFLUX

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ACHALASIA DIAGNOSIS MANOMETRY - BARIUM
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DYSPEPSIA
Implies chronic GORD IBS Ulcers Gall
Stones Cancer Functional
Implies chronic GORD IBS Ulcers Gall
Stones Cancer Functional (Alcoholic gastropathy)