Heartburn Flashcards
Differential diagnosis
GORD
Upper GI cancer
Peptic ulcer disease
Cardiac pain
HPC questions to ask
SOCRATES - retrosternal pain think GORD, epigastric think Peptic ulcer disease?
Any nausea and vomiting
Any cough? (especially at night?)
Red flag symptoms:
- Weight loss
- Difficulty swallowing
- Dark stools (malaena)
- Haematemesis
- Anaemia symptoms - tiredness
- Central crushing chest pain (rule out cardiac causes)
Ask about diet;
- Fatty foods
- Alcohol
- Coffee
PMH questions to ask
Hiatus hernia
DH
NSAIDs (aspirin, ibuprofen or naproxen) - can exacerbate/trigger peptic ulcer and GORD
FH
Any family history of cancer?
Any family history of GORD?
SH
BMI
Smoking
Alcohol
Stress/anxiety at work
SN and FU
If get weight loss, or dark stools or have trouble swallowing - come back to the GP - may need an endoscopy
If have central crushing chest pain - go to A&E
Follow up in a month
Examination and investigations
Abdominal examination
Weight and BMI
Feel lymph nodes
Look for signs of anaemia
Investigations:
- H. Pylori stool antigen
- FBC to rule out anaemia
Management of GORD
Lifestyle/self-management
- Weight loss
- Stop smoking
- Reduce alcohol
- Avoid triggers e.g. large meals, fatty foods, coffee, alcohol
- Eat smaller meals more regularly rather than large meals
- Avoid spicy food
- Raise your head in bed at night with pillows
- Relaxation techniques
- OTC antacids such as gaviscon can help in the short term
Prescribe PPI as a trial with follow up in a month to discuss
Management of Peptic ulcer disease
If H. pylori present - triple therapy (PPI plus 2 antibiotics e.g. clarithromycin and metronidazole)
PPI
Review NSAID use if this is the trigger
Management if any concerning features or over 55
Refer to gastroenterology on 2ww for endoscopy
