Internal Medicine

P1: RLJ/OZN P2: PSB

0521779407-D-02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:9

512 Dyspepsia Dysphagia

➣cholangitis

➣pancreatitis

■GERD

➣Barrett’s esophagus

➣stricture

➣ulceration/erosions

➣bleeding

■Gastroparesis

➣weight loss/nutritional complications

Prognosis

■80% of individuals with peptic ulcer will relapse within one year once

anti-secretory therapy is discontinued

■maintenance therapy with an H2RA or PPI decreases relapse to

10–15%

■of those infected with and cured of theirH. pylori20% will still have

an ulcer relapse

■patients with NUD have chronic intermittent symptoms

Dysphagia.........................................

ROY SOETIKNO, MD and MONA LIN, MD

history & physical

Signs & Symptoms

■Difficult initiation of swallow

■Sticking sensation during swallow

■Cough with swallow

■Gradual vs. sudden onset

■Solids vs. liquids

■Persistent vs. intermittent

■Weight loss may suggest malignancy

■Neuromuscular diseases (stroke, polio, Parkinson’s, myasthenia):

may be associated with speech deficits, weakness, muscle atrophy,

and sleep apnea

■Systemic sclerosis (calcinosis, Raynaud’s, sclerodactyly, telangiec-

tasias)

■Goiter, lymphadenopathy (extrinsic compression)

tests

■Radiology (video or barium swallow)