Abdominal malignancy masquerading as gastro-oesophageal reflux.

Gastro-oesophageal reflux disease is a common condition, and the typical symptoms of postprandial heartburn and upper abdominal pain usually respond well to acid-suppressive medication. Occasionally, the gastro-oesophageal reflux is secondary to gastric outlet obstruction, and rarely, it is due to more distal intestinal obstruction. Two patients are described who seemed to have a primary diagnosis of gastro-oesophageal reflux but who were subsequently found to have disseminated intra-abdominal malignancy. Further investigation beyond the endoscopic confirmation of oesophagitis should be considered in patients who have typical gastro-oesophageal reflux symptoms but who also have any associated worrying clinical features.

General practitioner and hospital specialist attitudes to functional gastrointestinal disorders.

BACKGROUND: Functional gastrointestinal symptoms generate a large workload in primary care. Research on functional gastrointestinal disorders is focused on hospital patients, but these patients may differ from those managed in primary care. AIM: To investigate any differences in attitudes of general practitioners and hospital specialists towards functional gastrointestinal illnesses. METHODS: A questionnaire was sent to 200 general practitioners and 200 British Society of Gastroenterology members. RESULTS: The response rate was 76%. Sixty-two general practitioners believed that functional gastrointestinal symptoms represented a 'real' currently unexplained gastrointestinal disorder, and 67 believed such symptoms probably represented somatization of a psychological illness. In contrast, most consultants (120) believed that functional gastrointestinal symptoms represented a 'real' gastrointestinal disorder, with only 36 perceiving them to have a psychological basis (chi2 = 26.7, P < 0.001). More consultants than general practitioners believed that the understanding of functional gastrointestinal disorders had improved in the last 20 years (chi2 = 4.31, P < 0.05). Most consultants and most general practitioners thought that treatment for these disorders had not improved over this period. Only 21% of general practitioners had heard of the Manning criteria for the diagnosis of irritable bowel syndrome, compared to 81% of consultants (chi2 = 107, P < 0.0001); 12% of general practitioners and 83% of consultants had heard of the Rome criteria for the diagnosis of functional gastrointestinal disorders (chi2 = 154, P < 0.0001); 37% of consultants used the Manning criteria and 40% used the Rome criteria; 11% of general practitioners used the Manning criteria and 3% used the Rome criteria. CONCLUSIONS: General practitioners and consultants have differing views on functional gastrointestinal disorders. In both primary and secondary care, most doctors do not use diagnostic criteria. Further research on the factors used to diagnose functional gastrointestinal disorders in primary care is warranted.