Gastroesophageal reflux disease

Revision as of 19:37, 31 January 2016 by Neil.m.young (talk | contribs)

Background

  • Affects up to 20% of population
  • Assume chest pain is cardiac origin until proven otherwise

Causes

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

Diagnosis

  • Pain and discomfort w/ meals
  • Chest pain w/ features similar to ACS:
    • Exertional, a/w diaphoresis, N/V, radiating to arm

Differential Diagnosis

Epigastric Pain

Management

  1. Avoid GERD exacerbating agents (ETOH, caffeine, nicotine, chocolate, fatty foods)
  2. Sleep w/ head of bed elevated
  3. Avoid eating w/in 3hr of sleep
  4. PPI or H2 blocker

Disposition

  • Home (outpatient treatment)

See Also

Source

Tintinalli