0071643192.pdf

EXAM

Cardiac and abdominal exam to rule out perforation and other causes of pain

DIFFERENTIAL

Infectious and other noninfectious esophagitis, gastroesophageal reflux disease

(GERD), functional dyspepsia, esophageal stricture or mass lesion, esophageal

motility disorders

■ Cardiac disease

■ Pulmonary disease

DIAGNOSIS

Endoscopy and empiric treatment with resolution of symptoms

TREATMENT

■ Discontinue the suspected drug. Expect symptom relief within 1–6 weeks.

■ Patients should drink 8 ounces of water with each pill and remain upright

at least 30 minutes afterward.

■ Proton pump inhibitors (PPIs) may facilitate healing in the setting of

concurrent GERD.

COMPLICATIONS

Perforation and strictures

Gastroesophageal Reflux Disease

Affects approximately 20% of adults; often related to incompetence of the

lower esophageal sphincter, hiatal hernia, or incomplete emptying of stomach

SYMPTOMS

■ Typical presentation: A retrosternal burning sensation (heartburn) is

accompanied by regurgitation that begins in the epigastrium and radiates

upward (typically occurring within 1 hour of a meal, during exercise, or

when lying recumbent) and is at least partially relieved by antacids. Water

brash (excess salivation), bitter taste, globus sensation (throat fullness),

odynophagia, dysphagia, halitosis, and otalgia are also commonly seen.

■ Atypical symptoms (up to 50%): Nocturnal cough, asthma, hoarseness,

noncardiac chest pain

EXAM

Exam is often normal, or patients may present with poor dentition and

wheezing.

DIFFERENTIAL

Infectious esophagitis (CMV, HSV, Candida), pill esophagitis (alendronate

[Fosamax], tetracycline), PUD, dyspepsia, biliary colic, angina, esophageal

dysmotility

DIAGNOSIS

■ For typical symptoms, treat with an empiric trial of PPIs for 4–6 weeks.

Response to PPIs is diagnostic.

ABDOMINAL AND GASTROINTESTINAL

EMERGENCIES