In practice a young patient with longstanding typical symptoms does not require investigation.
Investigation should be considered if the following features are present:
- atypical symptoms
- dysphagia
- short duration of symptoms in patient over 55 yr
- weight loss
The investigation of GORD consists of one, or a combination, of the following:
- endoscopy:
- the most common initial investigation
- can exclude other causes or dysphagia such as carcinoma
- is normal in up to 65% of cases
- symptoms requiring urgent referral of patients for endoscopy are (1):
- gastrointestinal bleeding
- iron deficiency anaemia
- progressive unintentional weight loss
- progressive difficulty swallowing
- persistent vomiting
- epigastric mass on palpation
- suspicious barium meal result or other suspicious imaging result
- factors requiring consideration of referral of patients for endoscopy include (1) :
- previous gastric ulcer
- previous gastric surgery
- non-steroidal anti-inflammatory drug use
- pernicious anaemia
- family history of gastric cancer
- barium radiology:
- may be used, particularly if a diagnosis of erosive oesophagitis is being considered
- 24 hour oesophageal pH monitoring:
- particularly useful if a link between symptoms and acid reflux needs establishing
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