Internal Medicine

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

Gastroesophageal Reflux Disease Gastrointestinal Bleeding 613

performed; preoperative 24-hour pH monitoring and esophageal

manometry necessary, as abnormal esophageal motility may affect

outcome; heals esophagitis in about 90% of patients; complications

prevented and remission maintained 80%

Side Effects and Complications

■Antacids: diarrhea or constipation; metoclopramide: drowsiness,

agitation, dystonic reactions and tremor; H2 receptor antagonists

are generally very well tolerated; proton pump inhibitors: abdomi-

nal pain, diarrhea, headache, nausea, and weight gain

follow-up

During Treatment

■Maintenance therapy is necessary to prevent recurrence of symp-

toms and complications; proton pump inhibitors in standard doses

are effective in maintaining remission

Routine

■“Once in a lifetime endoscopy” for patients with chronic, intermit-

tent reflux complaints who respond to medical therapy but have

frequent relapses to rule out Barrett’s esophagus

complications and prognosis

■Unexplained chest pain

■Chronic unexplained cough

■Chronic laryngitis and hoarseness

■Peptic strictures (in 10% of untreated cases)

■Barrett’s esophagus (30-fold – risk of adenocarcinoma)

■Adenocarcinoma or high grade dysplasia

Gastrointestinal Bleeding..............................

JOHN P. CELLO, MD

history & physical

■Upper GI bleeding (i.e., bleeding from esophagus, stomach and prox-

imal small bowel)

History

■Vomiting of grossly bloody (hematemesis) or “coffee grounds”

(melenemesis) material

➣Melena, dark liquid black (tar-like) stools