Summary

GERD is a chronic condition requiring long-term treatment. Potent acid-suppressive therapy is currently the most important and successful medical therapy. Step-up medical therapy can be accomplished according to Table 9-2. Although healing of esophagitis is usually achieved with a

Possible GERD symptoms

(confirm diagnosis)

(confirm diagnosis)

Ambulatory MII-pH monitoring

Ambulatory MII-pH monitoring

FIGURE 9-3. Suggested diagnostic gastroesophageal reflux disease (GERD) algorithm. GER = gastroesophageal reflux; MII-pH = multichannel intraluminal impedance and pH; PPI = proton pump inhibitor.

Nonacid GER with symptoms

Nonacid GER with symptoms

FIGURE 9-3. Suggested diagnostic gastroesophageal reflux disease (GERD) algorithm. GER = gastroesophageal reflux; MII-pH = multichannel intraluminal impedance and pH; PPI = proton pump inhibitor.

single dose of any PPI in over 80% of cases, symptoms are more difficult to control. Patients with persistent symptoms on therapy should be tested (with combined MII-pH or with pH probe) for association of symptoms with acid, nonacid, or no reflux. Long-term follow-up studies indicate that PPIs are effective, tolerable, and safe medications. Promotility agents have shown limited efficacy and their side effect profile often outweighs benefits.

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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