By Philip Katz MD
Dr. Philip Katz has designed this designated reference, which bargains professional suggestion, personal tastes, and evaluations on difficult medical questions in general linked to GERD. the original Q&A layout offers easy accessibility to present details with regards to GERD with the simplicity of a talk among colleagues. various photographs, diagrams, and references are integrated to reinforce the textual content and to demonstrate the therapy of GERD patients.
Curbside session in GERD: forty nine medical Questions presents details simple adequate for citizens whereas additionally incorporating professional recommendation that even high-volume clinicians will have fun with. Gastroenterologists, fellows and citizens in education, surgical attendings, and surgical citizens will enjoy the elementary and informal structure and the specialist recommendation contained within.
Some of the questions which are answered:
• Can scientific remedy modify the average heritage of Barrett’s esophagus?
• Can antireflux surgical procedure modify the common historical past of Barrett’s esophagus?
• How does being pregnant have an effect on GERD? Is GERD in being pregnant a possibility for long term reflux?
• what's the organization of weight problems and GERD?
• What are the so-called extraesophageal manifestations of GERD?
• Is there a gender distinction in reflux illness? Does this impact treatment?
Read Online or Download Curbside Consultation in GERD: 49 Clinical Questions PDF
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Extra info for Curbside Consultation in GERD: 49 Clinical Questions
This is particularly true in patients with laryngeal symptoms, who do not appear to respond to surgery if they have failed PPI. In my practice I would routinely perform impedance/pH testing in this patient for the following reasons. If continued acid reflux is demonstrated, antisecretory therapy can be changed, reassessed, or increased. Surgery can be considered, though I rarely do this until after a new/different medical therapy trial. If non-acid reflux is found associated with symptoms, the patient can be offered an explanation for continued symptoms and possible therapy.
I do not advocate extending the trial beyond 4 weeks, nor do I typically increase the dose empirically in treating typical symptoms unless I have a clear (greater than 50%) progressive improvement. Although 53 54 Question 14 switching drugs, changing dose timing to before the evening meal, adding an H2 blocker all have their support, I consider these part of long-term management or maintenance and not part of a therapeutic trial. So, if I am not happy with the response at 4 weeks, I would do a work up.
Several lines of evidence suggest a different approach to atypical (non-heartburn) presentations. A lower incremental response to once-daily therapy has been observed for all extraesophageal symptoms and many feel are the most difficult. It is in this group that I use the longest “trial,” 8 to 12 weeks of twice-daily proton pump inhibitor. This is the best compromise for most patients in my clinical experience. A more rapid response is gratifying and absolutely no improvement after 4 to 8 weeks suggests a low likelihood of GERD in my experience; but again, little harm will come to the patient—either physical or emotional—by waiting and in my experience reduces and focuses diagnostic testing.