Hello what is I'm doctor silva I'm from gastroenterology doctors how are you I'm all safe alright I think you're alright I'm good I hope I'm alright I'm thinking fine I'm fine the same think you're fine tell me about your pain so right so I suffer a big suffer I imagine depending on what you're eating you can just try reflux mhmm I prescribe the flux that because it didn't agree with me anyway I carried on taking on and on the amoxicillin not not all the time anyway 4 weeks ago I've just felt like I had something here in like just under the ribs mhmm where that little bit of lump is that which is that natural lump but it's something there it's like a I don't know how to describe it where it's a blockage or it's indigestion but it's not indigestion because I've taken a lot because I've taken gaviscon it's still there sometimes it's I can feel it more than others it's concerning me now because it's 4 weeks on of course and then whether it's related don't know yesterday I woke up and it has normal horrendous horrendous tummy tummy but a lot more pains like I was like not being a baby but I was on all fours and oh thank and spasms and then yeah and then I went about 6 6 times 7 times it just got darker and darker and darker so I contacted my gp which I've been meaning to do about this anyway because this is my main 1 so he preferred to just say good straight to a and e yeah and they'll yeah right and how dark did it get did it get to the color of your shoes like jet black it wasn't no I wouldn't say jet black but it was but it got quite dark dark yeah dark brown yeah like my shoes dark brown yeah maybe a bit darker maybe a darker yeah mhmm gp said possibly it was yeah okay I don't know yeah but this thing you hit whatever this is it's like and then sometimes I can feel something there like burning at the back cool burning no not that because I have that before yeah if I'm drinking like a red wine or coffee something like red yeah but then I'll just take amoxil it sort of like slows you down really or a gaviscon but yeah because the amoxil slow releasing isn't it yeah amoxil works by decreasing the acid production in the stomach because the lady in a and e last night she told me to go home and take my then potentially compensation by the end of day because she said just carry on taking your amoxil regularly yeah mepso works best when you take it regularly does it it doesn't work fantastically as a rescue therapy yeah of course not no one's really told you so it doesn't work very well as a rescue therapy right okay gaviscon works well when because it forms like a floating spongy cap over your stomach okay so it drops into your stomach and forms a cap which means that nothing's able to come up and the esophagus is the bit that's very sensitive to acid so when acid washes up over the lower gullet that causes the discomfort that you're experiencing and it may well be that you've got some inflammation at the bottom of the esophagus a bit of esophagitis that that's causing your symptoms it just feels like something it's very common lots of people will tell me that but it feels like there's a lump there it feels like things are getting stuck maybe little bits of bread are getting stuck there and when the oesophagus is inflamed it can irritate that area and pain is very poorly localized from the gastrointestinal tract you don't have very good pain senses there you get all I'm the natural not done the worst so I interrupted no sorry the worst thing ever I'll googled it oh I'm sorry yeah fine it goes on I've got something yeah awful cancer pancreas cancer is there any family history of that or anything like no no good fine you've been losing weight I should have said this in the beginning the last 4 weeks I was I've been feeling very tired and I've had loss of appetite I just put that down to the hot weather the last couple of weeks which was really hot tiredness I'm not I'm not really that I'm I'm alright with tiredness now it seems to be alright again but I've not really got a muscle appetite yeah I find that I'm eating but just because it's mealtime but I don't really fancy anything I'm not really about having mealtime and then if I don't eat like yesterday I didn't eat at all because of my but my stomach will tell me that I'm hungry because of the grumbles or any sort of thing or whatever it's saying I need something but I'm just like mhmm I'm awake for a long time yeah when the stomach's inflamed and unhappy and stuff like that and it's that that loss of appetite has been over the last say 3 3 weeks 3 weeks oh it's the same. Weeks. It's gonna be this loss of weight I have been weighing myself it did go down but it seems to in the over the last 4 weeks yeah yeah that's good for me sherry normally around like 67 kilos but 10 will pass down 11 yeah I did drop down to 10 yeah a week or so ago but I'll weight myself good fine so that's reassuring as well the other reassuring thing is your blood tests which shows that you're not anemic and that you haven't lost a lot of blood which is good your liver tests which usually will go off when there's something wrong with the pancreas that's entirely normal and the level of inflammation in the blood if there's something sinister and worrying going on there'll usually be rates of inflammation and you also plummet all those things are very reassuring in terms of something really nasty going on on the head I strongly suspect that you have inflammation of the stomach or inflammation in the lower oesophagus either in gastroparesis exactly in that exact spot the stomach is just here so in the upper tummy you think it's there wouldn't you you think it's there yeah but it's a small structure at the top of the abdomen almost in the chest really yeah so it's so I I suspect that's what's causing the symptoms can I touch your tummy and look at your hands that alright yeah thank you I'll just switch my hands for me what do you do for a living I'm a marine engineer so what kind of things do you work on you work for the military you oh no princess yachts okay yeah super yachts I work in the yeah amazing so what are you building on super yachts what are we building what what do you do on a game engineer so to you I would fit anything from they fit any engine to entertainment system to yeah are they they sort of on-site do you build them on-site or are they on-site amazing yeah made and put them off crafted made and sent to the rich to the very rich over the world isn't all over the world do you feel much better in this lady that's not particularly tender no it's not too tender therefore you're a bit of a stomach chap and I can't feel any lumps or bumps very tricky oh what I do take sorry is I take prescribed by the doctor was gonna name cool cool okay I take that every 10 is the other 1 meal I take it it varies but I do take that I would say at least 2 to 4 a day right that's due to I'll get side effects and I'll get I suffer through my job like my lower back shoulder yeah right I see my gp years ago said change your career before your career changes you I'm still doing it it's like do know I mean yeah so you mask a bit more kind things that are bad I didn't know if I was creative I didn't know if I was doing it certainly it can cause constipation which can cause tummy pain but it doesn't sound like constipated it sounds like more like the other way sometimes it depends how many I take yeah I do notice if I do take it more mhmm so you've come off of I'm not and like but your bowel habits usually yeah they're alright yeah I'm not like I can't tell you bang on something like every morning I'm not like no I'm just on the oral or place depending on yeah food and drink and times of going to bed or work and stuff mhmm and then the co colem oil you're taking do you take any naproxen still I don't take naproxen at all good good yeah stop the bromine I don't take it does irritate the stomach something something's wrong ibuprofen that seems good you don't take that either did you use aspirin at all sometimes you sat on the painkiller tylenol and prozac yeah fine that's fine good so that's not gonna irritate your stomach at all which is it's not no oh okay cool cool but you know that cocodone has paracetamol in it yeah so you're over just compressible good I'm glad great so your tracing of your heart's lovely we're gonna repeat it in a minute just to make sure that there's no dynamic changes just because sometimes very rarely people can have problems with the heart that present like pain in tummy and I think it's covering all the bases but certainly there's no sign of anything worrying when we get blood tests in terms of what we do to investigate this tummy discomfort I would suggest an upper gi camera test as the a and e doctor that that might be something that we need to consider have you thought about that before or anything like that I don't know I mean your hands yeah yeah so so we use a thin flexible camera it's about the size of my finger we make we lay down in our endoscopy unit we're sleep you with some sedation and spray the back of your throat with some throat spray so you can't feel the camera too well on your hands then we pop our camera in and have a look around for about 10 minutes or so and that will help us determine if there's any pain can I just take a second hello that's all right it'll tell whether us there's any inflammation in your stomach or in your lower gullet it'll take a small sample from your stomach to see whether there's an infection there h pylori that can cause a sudden onset of tummy discomfort like you're experiencing and we can also have a look into the small intestine and make sure there's nothing there causing a symptom it's a very good test quick test and it gives us lots of good information that's causing symptoms and I suggest that be a sensible thing to do sometime soon is that alright you're the expert on with the thing think that'd be a sensible too and I can arrange that for you poor jag reflex very sensitive or bad sensitive put the toothbrush in I would definitely suggest having an isolation unit and if you need someone to look after for the evening after that and we recommend not operating heavy machinery or driving 24 hours after it but I would if you have a strong gag reflex and you're a young man it's an unpleasant test but but because if you have a bad gag reflex it can be an unpleasant test most people are fine but some people with a very bad gag reflex don't enjoy it so I'd have some sedation and you if you're very sleepy and you won't remember it okay it'd be good alright sorry go on sorry there's a patient I haven't eaten today well I had a piece of toast I went to the toilet quite quickly so that's fine I'm just waiting I'm just hanging for yeah yeah yeah the medication so you need to start the night before the test so we start for 6 6 hours usually before the test to get all of this information I don't think we'll be able to do the test today okay because you need to be booked in for it prepped consented and have and obviously be starved for it so a sensible thing to do would be to go home on some increased omeprazole and come back over the next few days to have it done I'll book you in the quickest slot you have which will happen sometime in the next few days okay come in to have that done I'll book you as someone who might be bleeding I don't think you bleeding because your blood counts are fine yeah given you have that done at all I think it's prudent to to bring you in as soon as possible to see if there's any inflammation there okay alright yeah lovely and you're taking 20 of the you're on 20 of the omeprazole 21 it's 20 of 80 so I double it yes you have 3 yeah take 2 take 40 mg once a day right and keep doing that until your end of the day alright so the last 1 was about 02:30 last yesterday morning when I got home from a and e so can I get this afternoon yeah you can take it this afternoon you can split the doses or you can take if you want to you can have 20 20 in the evening that's absolutely fine they'll they'll work very similarly to be honest with with you as taking 40 in 1 day as long as you take them then I think you'll feel better and then use gamscon as when you need to for those moments yeah you can take that along the top alongside yeah some people use rennie's as well you can have that alongside as well and throw throw the book at it would say to get yourself feeling better so that we can get that endoscopy and find out what's going on and then take it from there okay so it's a camera down for a bit exactly yeah okay is that okay yeah okay great I'll get another source of noise in a of course when am I looking at when are you looking at getting it done yeah it'll be sorry go on gone because I am due to go away anything thursday and I'm back on friday fine okay afternoon so it'll probably be tomorrow or the next day it'll so probably be wednesday or thursday that I'll give you an appointment so you can that's it exactly but or you can also say to our appointment sorry I really need to do this put me on on this day yeah that's fine okay okay lovely well because I'm gonna call you from the office probably later today to book no no no they'll call you they'll call yeah they'll call you to arrange the test lovely yeah is that okay and give you the information about it and starting and sending and I'm not having an ecg again mate oh yeah you are aren't you we were gonna repeat it from the stop me you're all right no no no are I forgot about that it'll be sorry I forgot well remembered so they're not gonna burst need to go ahead yeah it it just was just like like little bit I'll be done like between okay so yeah yeah I I will be grateful but we request we request an outpatient formal 1 so that it's for your records exactly how much will they so if if you will come to your clinic basically with a with ultrasound once she's done the compression unlikely gi bleed plan patient is alan tickel 976634 impression very unlikely upper gi bleed more likely esophagitis + or - gastritis secondary to gastroesophageal reflux disease plan number 1 outpatient ogd on gi bleeding pathway number 2 double dose omeprazole until ogd number 3 consider stopping ppi and undertaking h pylori stool antigen testing after agd