Internal Medicine

0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:47

610 Gastroenteritis Gastroesophageal Reflux Disease

General Measures

■handwashing and other hygienic measures

■avoid antimotility agents, if invasive infection suspected

■avoid anti-emetic agents, if toxin ingestion suspected

■notify health department, if foodborne outbreak suspected

specific therapy

■antimicrobial agents (see food poisoning and infectious diarrhea

chapters)

follow-up

■most gastroenteritis (especially viral) is self-limiting: rehydration

and general measures sufficient

■if symptoms persist:

➣reevaluate patient

➣assess severity and need for hospitalization

➣repeat stool studies

➣consider endoscopy with biopsy

complications and prognosis

■uncommon to develop sequelae

■post-infectious irritable bowel syndrome

■persistent infection (G. lamblia, immunocompromised host)

■unmasked underlying disease (IBD, celiac disease)

■see infectious diarrhea and food poisoning chapters

Gastroesophageal Reflux Disease.........................

GEORGE TRIADAFILOPOULOS, MD

history & physical

■GERD=spectrum ranging from heartburn or acid regurgitation

alone (non-erosive reflux disease, NERD) to reflux esophagitis and its

complications, including esophageal ulcers, strictures and Barrett’s

esophagus

Risk Factors

■lower esophageal sphincter (LES)=key mechanism responsible for

GERD

■Transient lower esophageal sphincter relaxations (tLESRs) account

for the majority of physiologic and pathologic reflux