Chest Pain

GERD-related chest pain may mimic angina pectoris, even to the point of worsening with exercise. Recent studies by Hewson and colleagues (1991) suggest that about 25 to 50% of patients with noncardiac chest pain have GERD. Multiple placebo-controlled studies now confirm the efficacy and cost savings of a therapeutic trial of a PPI to make the diagnosis and treat this syndrome. In the best study to date, Fass and colleagues (1998) found that a 7-day trial of omeprazole (Prilosec) 40 mg in the morning and 20 mg in the evening had a sensitivity of 78% and specificity of 85% for predicting GERD, when compared with traditional esophageal tests. Additionally, they found a savings of $573 per average patient due to a 59% reduction in the number of diagnostic tests (ie, upper gastrointestinal endoscopy and 24-hour pH tests) performed in these patients. From a practical standpoint, I give the patients a 1-month trial of a PPI taken twice daily, with further testing based on the response at follow-up. There is a separate chapter on esophageal motility disturbances and chest pain (see Chapter 17, "Esophageal Strictures").

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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