Investigation and management of dysphagia/retching
| Investigations of choice | Differential diagnosis | Therapeutic options |
| CT+PET scan±endoscopy | Tumour progression/recurrence | Refer back to MDT |
| Endoscopy | Benign stricture | Dilation±self-expanding plastic/removable metal stent, long-term acid/bile suppression, dietetic advice/enteral feeding tube |
| Inflammatory (acid/bile/pepsin-related) | Sucralfate/proton pump inhibitor/promotility agents | |
| Infection (fungal/viral small bowel bacterial overgrowth) | Specific antibiotic | |
| Radiological contrast swallow±endoscopy | Spasm/abnormal peristalsis | Calcium channel antagonists, low-dose antidepressants |
| Dysmotility/reflux/slow transit through upper GI tract | Sucralfate/proton pump inhibitor/promotility agents (domperidone, low-dose erythromycin (250 mg bd), paroxetine, subcutaneous naloxone), dietetic advice, enteral feeding tube |
MDT, multidisciplinary team; PET, positron emission tomography.