Heartburn_Dyspepsia Fall 2012 (1)

Anticholinergics nitrates calcium channel blockers

Info icon This preview shows pages 10–25. Sign up to view the full content.

Anticholinergics Nitrates Calcium channel blockers
Image of page 10

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

Contributing Factors Smoking Pregnancy Obesity
Image of page 11
Triggers Acidic foods Citrus foods Tomato based foods Spicy foods Alcohol Caffeine Fatty/fried foods Garlic Peppermint Chocolate
Image of page 12

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

Medications: Direct Irritants Aspirin Non-steroidal anti-inflammatory drugs (NSAIDs) Ibuprofen, naproxen Potassium chloride Bisphosphonates Alendronate (Fosamax®), risedronate (Actonel®) Chemotherapy
Image of page 13
Heartburn Diary Accessed October 12, 2009
Image of page 14

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

Clinical Presentation Typical symptoms Dyspepsia Belching Acidic taste Regurgitation Hypersalivation Atypical symptoms (extraesophageal) Pulmonary symptoms Cough Asthma-like symptoms Laryngo-pharyngeal symptoms Laryngitis Pharyngitis Non-cardiac chest pain
Image of page 15
Clinical Presentation: Alarm Symptoms Dysphagia Odynophagia Choking Upper GI bleeding Hematemesis Hematochezia/melena Hemoptysis Weight loss Anorexia Early satiety Persistent N/V/D Chest pain Exclusions to self-care
Image of page 16

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

Complications Ulcerations and/or hemorrhages Strictures Narrowing of the esophagus Barrett’s esophagus Esophageal cancer
Image of page 17
When is Self-Care Inappropriate? Heartburn > 3 mo Heartburn continues > 2 wk after treatment with H 2 antagonist or PPI Heartburn while taking recommended dosages of nonprescription H 2 antagonists or PPI Heartburn and dyspepsia occur while taking prescription-strength H 2 antagonist or PPI
Image of page 18

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

When is Self-Care Inappropriate Continued? Severe heartburn/dyspepsia Nocturnal heartburn Any presence of alarm symptoms or complications* Pregnancy/lactation Especially for severe/frequent symptoms Pregnancy: calcium/magnesium Lactation: magnesium/aluminum Children <12 yr (for antacids or H 2 antagonists) <18 yr (for PPIs) *Consider referring to urgent care
Image of page 19
Treatment Guidelines Goals of therapy Prevent meal-time and exercise related symptoms Improve quality of life Prevent complications Lifestyle modifications May benefit patients with GERD Unlikely to control symptoms in the majority of patients
Image of page 20

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

Treatment Guidelines Antacids and OTC acid suppressants Options for self-treatment Persistent symptoms warrant further evaluation and treatment Acid suppression Mainstay of therapy H 2 antagonists Dyspepsia, mild GERD Proton-pump inhibitors (PPIs) Moderate/severe/frequent GERD, esophagitis
Image of page 21
Nonpharmacologic Management Lifestyle Modifications Avoidance of exacerbating factors Wear loose fitting clothes Weight loss if overweight Raise head of the bed 6 inches Smoking cessation Dietary Changes Eat small, frequent meals Avoid eating within 3 hours of lying down Avoid foods that are irritating Avoid foods that reduce LES Limit alcohol consumption
Image of page 22

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

Pharmacologic Therapies Antacids Histamine 2 receptor antagonists (H 2 RAs) Proton pump inhibitors (PPIs)
Image of page 23
Antacids Useful for heartburn, dyspepsia and as adjunctive therapy
Image of page 24

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

Image of page 25
This is the end of the preview. Sign up to access the rest of the document.
  • Fall '12
  • lipsh
  • adverse effects, Gastroesophageal reflux disease, proton pump inhibitors, heartburn

{[ snackBarMessage ]}

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern