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afya
GORD
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> ''Symptoms'' Heartburn and Acid regurgitation also - chest pain, globus pharyngeus, resp (cough), ENT (dysphonia, post drip, throat clear) ''worry / refer'' IF - over 40, dysphagia, pain on swallowing, wt loss, anaemia, dark stool, OR - FH, n&v, nocturnal Sx ''Mx '' - aim to relieve Sx, heal tissue, prevent complications / relapse ''Behaviour modify'' raise end of bed by 15 cms beware - fatty, citrus, alcohol, chocolate, tomato, coffee, mint Drugs - anticholinergics, theophylline, CCB, tricyclics, BB, alendronate stop smoking, loose weight, small meals, don't lie down for 2 hrs post food ''PPI'' relieve Sx and heal oesophagus faster than H2 use full dose 6-12/52 then on demand NICE says use for severe disease - H2 for mild SE - d&v&n, also dry mouth / taste disturbance, rarely peripheral oedema, interstitial nephritis Occ metoclopramide used for Sx but beware Parkinsonism long term ''Relapse'' Not fully understood - only 15% oesophagitis progress, but 80% relapse off drugs use PPI to maintain at lowest dose possible to relieve Sx (or H2 if PPI not tolerated) refer for surgery - if high does needed to maintain Sx according to clinical condition of pt ''DD'' Peptic ulcer gastritis cancer drugs - beware - Theophylline, ISMnitrate, Nifedipine, NSAID ''Surgery'' - fundoplication useful for chronic severe unresponsive to PPI ?refer if complications - stenosis . ulcer . barretts ?? may help with resp Sx eg asthma - ? improves Sx but not pulmonary function ?? ''Endoscopic treatment ''- not recommended ''In pregnancy'' 30-50% women c/o heartburn, oesophagitis is usually mild resolves soon after delivery lifestyle advice, then antacids or H2, NOT PPI usually
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