Your next patient in clinic is a 38-year old man who has been referred by his GP with treatment-resistant dyspepsia.  

He tells you that for the last 6 months he has been experiencing a burning sensation in the upper abdomen, bloating, and belching which occurs mainly after eating and can last up to an hour.  He finds that Omeprazole 20mg helps with his symptoms, but as soon as he stops taking this, his symptoms return.     

He does not experience acid reflux, vomiting, and has not lost any weight.  

He is a computer programmer, and his job is quite sedentary.  His diet is varied, but he admits that it could be healthier, and he is trying to cut back on his alcohol intake – he currently drinks around 20 units per week (mainly ale).   He does not smoke. His BMI is 26. He does not take any regular or irregular medications.  He has struggled with low mood for some time and has received some psychological therapy for this over the last couple of years.  

His GP has been struggling to manage his symptoms.  Investigations to date include bloods (all normal).  He and his GP wonder if an endoscopy might be helpful.  The patient is worried about his symptoms, and although he has no family history of gastric cancer, he worries about this.  He also wants to know what is causing his symptoms and worries about taking medication long-term.