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* GERD mx
  dolly123 - 11/12/06 13:13
  in a case of GERD ( sugg by history only ) whats the protocol step by step

1. PPI trial
2. no response -> endoscopy
3if endoscopy is negative-> do ph monitoring

is this correct?
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* Re:GERD mx
  malak - 11/12/06 13:22
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* Re:GERD mx
  dolly123 - 11/12/06 13:24
also some more confusion

is the endoscopy interchangeable with esography in this protocol or both have different indications ?
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* Re:GERD mx
  uterus - 11/12/06 15:28
  If its a very mild sporadic type of GERD what sugg by history you dont go straight to the most potent and expensive therapy, you go for antacids and H2 blockers first,
In fact by the time you prescribe PPI the diagnosis must be done with PH-monitoring, endoscopy doesn't confirm the diagnosis of GERD, but the complications of GERD
Actually 95% of patients will respond to PPI therapy if its a truly GERD, and only 5% who doesn't not respond will need to undergo surgery to tighten the sphincter
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* Re:GERD mx
  malak - 11/12/06 15:40
  endoscopy---to exclud other pathology
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* Re:GERD mx
  uterus - 11/12/06 15:51
  agree, but the order of procedures mentioned above doesn't seem to be correct  
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* Re:GERD mx
  ben - 11/12/06 18:57
  I would go w/ Antacid then PPI over H2 blockers as they are more effctive than H2 in severe GERD Sx's vs H2 used in mild Sx's of GERD. But overall Mx should begin w/ Lifestyle Modifications plus type of Meds, depending on Case. If Ineffective Endoscopy then Ph monitoring if Endosc was inconclusive  
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* Re:GERD mx
  ben - 11/12/06 19:00
  Endoscopy shuld be done 1st to r/o complications such as cancer which is much more impt than ruling out GERD 1st  
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* Re:GERD mx
  dolly123 - 11/12/06 19:02
  thx ben

so essentially the mx is
1. meds (dep on severity of s/s we go antacids--->PPI--->H2+/-
2. no response --->esophagograhy/scopy
3. inconclusive---> ph monitoring

my next q was how to d/d whether to use Ba swallow or endoscopy to visualize in step 2
do we do less invasive first?
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* Re:GERD mx
  malak - 11/12/06 19:09
  this depend on the age of pt ,presence of risk factors and c/o pt

old age smoking ,progressive dysphagia , wt loss --do br 1st then endoscopy

young age with heartburn,regargitation give trial of ppi if no improvement do endoscopy if normal do 24 hrs ph moniter
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* Re:GERD mx
  ben - 11/13/06 10:41
  any cases that mentions "dysphagia" - BS 1st  
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