Gastrointestinal

Question 1

Treatment for uncomplicated GERD? what do you do if this treatment plan fails? What if the second treatment plan fails?

Answer 1

• once daily PPI for 2 months
• if this doesn’t resolve Sx then switch to a different PPI or increase the current PPI to twice daily
• if this still doesn’t resolve Sx, consider upper GI endoscopy or esophageal pH monitoring (looking for another cause of Sx)

Question 2

indications for upper GI endoscopy in patients with GERD?

Answer 2

• alarm symptoms
• age >50
• symptoms for > 5 years
• risk factors for cancer like tobacco use

Question 3

What are the alarm symptoms for patients with GERD?

Answer 3

• dysphagia, odynophagia, recurrent vomiting
• hematemesis, melena, GI bleeding, anemia
• weight loss