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  • Dr Simon Moore MD CCFP

Don’t Let Dyspepsia Turn Your Stomach


One of the most common questions we get from residents interested in The Review Course is,

“How are you going to teach all of the family med exam topics in 2 days?”

To answer this question, let’s look at what you need to know for Dyspepsia. We are committed to helping residents succeed when writing the Family Med exam.

When peparing for the Family Medicine exam, for a patient with dyspepsia, you must be able to:

  • rule out cardiac causes

  • determine the cause

  • know the alarm features

That’s it! Because there are several brief topics like this (which will actually be covered in separate lectures on Chest Pain or Abdominal Pain), The Review Course will have sufficient time to serve as a fast-paced, high-yield review of the most important things to know about the family medicine exam.

As well, we can easily cover all of the content because we are reviewing the material in an efficient manner, rather than teaching it for the first time. Our course will focus on:

  • Need-to-know information for the family medicine exam

  • Relevant Canadian guidelines

  • Recent changes in the Canadian guidelines

  • And much more


DITCH THE BARIUM SWALLOW? - Barium investigations are no longer recommended as first-line for investigation of dyspepsia, or for most gastrointestinal disorders. In fact, some radiology departments in Canada no longer do barium swallows and will reject a requisition for one.

According to the Canadian Association of Radiologists imaging guidelines, the barium swallow should only be used for investigation of motility disorders because it can show subtle strictures not seen on scope, as well as webs and pouches.

The CAR guidelines list endoscopy - not barium swallow - as the recommended initial investigation of choice for:

  • dyspepsia

  • dysphagia

  • ulcer diagnosis and follow-up

  • acute and chronic GI bleed

  • heartburn (if medical therapy fails, but pH monitoring is the gold standard for diagnosis)

RED FLAGS - According to the CMA's helpful list of guidelines, there are unfortunately no Canadian guidelines on Dyspepsia. Other useful resources include the BC guidelines on Dyspepsia, as well as this review article on Dyspepsia.

These two resources recommend assessing for higher risk of serious pathology by inquiring about the above red flags, plus:

  • Early satiety

  • Persistent vomiting

  • Odynophagia

  • Family History of upper GI cancer

  • Onset over age 50-55 (depending on the resource)

Referral for endoscopy is recommended for patients with red flags.

Only a few weeks remain for The Review Course early bird discount. Find out more

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