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■ Antacids (calcium carbonate, aluminum hydroxide): For mild GERD;

fast but afford only short-term relief

■ H 2 -receptor antagonists (cimetidine, ranitidine, famotidine, nizatidine):

For mild GERD or as an adjunct for nocturnal GERD while the patient is

on PPIs; effective in 50–60% of the cases

■ PPIs (omeprazole, lansoprazole, rabeprazole, pantoprazole, esomepra-

zole):The mainstay of therapy for mild to severe GERD; generally safe

and effective but now associated with pneumonia, atrophic gastritis (hyper-

gastrinemia), enteric infections (Clostridium difficile), and hip fractures;

daily dosage effective in 80–90% of patients; fewer than 5%of patients are

refractoryto twice-daily dosage

Caustic Ingestions

May be a suicide attempt in adults, whereas most ingestions in children are

accidental

SYMPTOMS

Presents with chest pain, dysphagia, and drooling

EXAM

Local burns to the oropharynx, edema, and sloughing of GI tract that may →

obstruction

DIAGNOSIS

■ History and physical

■ CXR to identify perforation

■ Endoscopy or bronchoscopy to identify extent of burns

TREATMENT

■ IV fluids and antibiotics

■ Do not induce vomiting.

■ Severe burns may require emergent esophagectomy.

■ Serial exams to rule out esophageal stenosis and need for stenting should

be performed.

COMPLICATIONS

Perforation, stenosis, strictures

Dysmotility

Dysmotility can be broken down into two classifications (see Table 11.2).

Oropharyngeal dysphagiadescribes abnormality in transferring food from the

pharynx to the esophagus. Esophageal dysphagiadescribes difficulty in transfer

to the stomach from the upper esophagus.

Foreign Bodies

Eighty percent of ingestions are by children.Others at risk include psychi-

atric patients, prisoners, and those with altered mental status. More than 50%

of ingestions are coins. Objects remained lodged in places of physiological

narrowing. In children, this is the level of the cricopharyngeus muscle (C6).

In adults, the most common place is just above the lower esophageal sphincter.

ABDOMINAL AND GASTROINTESTINAL

EMERGENCIES

Both ACS and GERD or

esophageal spasm may be

relieved by nitroglycerin.

Alkali burns cause liquefaction

necrosis (much more serious),

whereas acidic burns cause

coagulation necrosis.