Gastroesophageal reflux disease: Difference between revisions

Revision as of 17:26, 29 October 2016

Decreased pressure of lower esophageal sphincter
- High-fat food
- Nicotine
- Ethanol
- Caffeine
- Meds (mintrates, calcium-channel blockers, anticholinergics, progesterone/estrogen)
- Pregnancy
Decreased esophageal motility
- Achalasia
- Scleroderma
- Diabetes
Prolonged gastric emptying
- Anticholinergics
- Outlet obstruction
- Diabetic gastroparesis
High-fat food

Patients who come to the Emergency may present with various symptoms, both typical and atypical.

Typical symptoms, may include: heart burn, regurgitation of food or dysphagia.
Atypical symptoms include noncardiac chest pain, asthma, pneumonia, hoarseness, and aspiration.

Pain and discomfort with or right after meals
- typically described as burning pain
- often worse when lying flat
Chest pain with features similar to ACS:
- Exertional, associated with diaphoresis, nausea/vomiting, radiating to arm

Reflux is physiologic in infants
Pathologic only if it causes complications, such as:
- failure to thrive/weight loss
- esophagitis
- respiratory disease: refractory asthma, recurrent pneumonia, apnea
- BRUE

Avoid GERD exacerbating agents (ETOH, caffeine, nicotine, chocolate, fatty foods)
Sleep with head of bed elevated
Avoid eating within 3hr of sleep
PPI or H2 blocker
Infants: small frequent feeds, avoid semi-supine position (e.g. carseat, carrier) right after feeds
- medications only if significant complications

Authors:

@@ Line 21: / Line 21: @@
 ==Clinical Features==
+Patients who come to the Emergency may present with various symptoms, both typical and atypical.
+* Typical symptoms, may include: heart burn, regurgitation of food or dysphagia.
+* Atypical symptoms include noncardiac chest pain, asthma, pneumonia, hoarseness, and aspiration.
 *Pain and discomfort with or right after meals
 **typically described as burning pain