Possible Nonacidic Reflux

Some authorities, however, suggest that these patients still may be suffering from "nonacidic" reflux. New technology such as impedance combined with pH testing allows the measurement of acid and nonacid reflux high into the esophagus. In our experience with impedance, as well as the older Bilitec technique, which measures bilirubin as a surrogate marker of bile reflux, we found that high doses of PPIs predictably eliminate both acid and nonacid GERD. Rarely, if ever, would I consider antireflux surgery for these patients. Certainly, if they have no symptoms of classic GERD and fail PPIs, with evidence of good control by 24hour pH testing, the logic for antireflux surgery is only based on the premise of nonacid reflux, which is precarious at best. On the other hand, patients with classic reflux symptoms and atypical complaints may be offered surgery if their heartburn and acid regurgitation symptoms respond well to PPIs, they have appropriate physiology, and they understand the side effects that may be associated with antireflux surgery. The logic here is that these patients have GERD, and surgery offers an appropriate and effective alternative treatment, but no guarantees are made about how their extraesophageal complaints will do.

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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