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Diagnostic testing is not needed in this setting

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Diagnostic testing is not needed in this setting; empiric PPI therapy for 8 weeks should beinitiatedIf cerebral palsy is present, cardiac evaluation is recommended before starting empiric PPItherapyEndoscopy is recommended for patients with GERD symptoms that do not respond to empiricaltrial of PPI therapy or who experience dysphagiaAmbulatory esophageal pH testing is indicated when considering endoscopyInfants and children:
oHistory and physical sufficient to reliably diagnose reflux, recognize complications, andinitiate management in most infants with vomiting, and in older children withregurgitation and heartburnoUpper GI study to evaluate presence of anatomic abnormalitiesoEsophageal pH monitoring: acid refluxoEndoscopy and biopsy assess presence and severity of esophagitis, strictures, andBarrett’s esophagus; exclude other disordersoEmpiric medical therapy for a trial period to determine if reflux is causing specificsymptomsNONPHARMACOLOGIC MANAGEMENTEducation: physical causes of GERD, common aggravating and ameliorating factors, and lifestylechanges to control GERD:oAvoid recumbence for 2 hours after mealsoElevate head of bed, including entire chestoWeight loss if indicatedoReduce size of meals and amount of fat, acid, spices, caffeine, and sweetsoSmoking cessationoReduce alcohol consumptionoAvoid stooping, bending after mealsoDo not wear tight-fitting garmentsSelective elimination of caffeine, chocolate, alcohol, and acidic foods is recommended since theydecrease the lower esophageal sphincter and cause symptoms in some patientsSurgical interventions, crural tightening or fundoplication reserved for patients with stricture,hemorrhage, Barrett’s esophagitis, chronic aspiration or intractable symptomsInfants:oMilk thickening: reduces episodes of vomitingoSupine position for sleep to reduce risk of sudden infant death syndrome (SIDS)oDiet changes: hypoallergenic formulaChild or adolescent:oPosition left side with head of bed elevatedoLifestyle changes:Avoid caffeine, chocolate, spicy foodsAvoid cigarette smoke and alcohol useWeight controlPHARMACOLOGIC MANAGEMENT8-week course of PPI therapy is treatment of choicePPI therapy should be dosed once a day and before the first meal of the dayIf partial response to daily PPI, increase to BID dosingIf symptoms persist after 8 weeks of PPI therapy, consider low-dose PPIs or H2 blockers formaintenance therapy
GASTROESOPHAGEAL REFLUX DISEASE PHARMACOLOGIC MANAGEMENTClassDrugGeneric name(Tradename®)DosageHow SuppliedCommentsAntacidsNeutralizehydrochloric acidin the stomach torapidly cause pH toriseGeneral commentsBlocks absorptionof many drugs:digoxin,tetracyclines,benzodiazepines,iron and otherscalciumcarbonateAdults: chew 2-4 tabsas symptoms occurMax: 15 tablets in 24hoursChildren: notrecommendedPregnancy: may useDo not use maximum dosage formore than 2 weeksFDA has not evaluated and approvedthis OTC product for reflux

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