Medicines that are partially subsidised attract a standard prescription fee the first time a prescription is dispensed but not when a repeat supply is dispensed , and a portion of the cost of the medicine per unit of medicine that is dispensed. For example, Mylanta Double Strength tablets have a higher part charge for the patient than the liquid preparations above; one way to reduce the cost to patients is to prescribe fewer tablets, e. It is unclear whether PPIs reduce the risk of a patient developing oesophageal adenocarcinoma.
Heartburn during pregnancy is more likely in women who have had previous episodes or multiple pregnancies, and is inversely correlated with maternal age. The clinical features of GORD during pregnancy are the same as for the general population. The treatment of GORD during pregnancy is conservative and many women with mild or infrequent symptoms can be managed by lifestyle, dietary modifications and the use of antacids or ranitidine Pregnancy Risk Category B1.
Many women with GORD during pregnancy will find that their symptoms rapidly improve after giving birth and continued treatment is not necessary. Omeprazole and pantoprazole are considered compatible with breast feeding, but caution is recommended with lansoprazole due to insufficient data.
Follow us on facebook. Decision support for health professionals ». South Island general practice support ». Practice acquisition and careers in health ». Click here to register ». Forgot your login? Login to my bpac. Remember me. Gastro-oesophageal reflux disease GORD and its complications Reflux of the contents of the stomach into the oesophagus is a normal physiological event that occurs in many people after eating.
The pathophysiology of GORD The most common cause of gastric reflux is periodic relaxation of the lower oesophageal sphincter. Nearly all patients with severe GORD have a hiatus hernia which can be diagnosed on endoscopy.
The complications of GORD Chronic exposure of the oesophagus to gastric reflux can result in a number of complications requiring long-term management.
Red flags for patients with GORD requiring endoscopy include: 1 Dysphagia difficulty with swallowing ; which may be caused by inflammation, abnormal peristalsis or oesophageal hypersensitivity. Odynophagia pain with swallowing ; which is generally associated with severe oesophagitis Haematemesis Weight loss with no obvious explanation Patients aged 55 years or older with unexplained and persistent dyspepsia of recent onset; these patients are at increased risk of gastric and oesophageal cancer.
The role of endoscopy The role of endoscopy is limited in the diagnosis of GORD as the majority of patients with GORD will not have oesophageal abnormalities on endoscopy. Extra pillows should not be used as they may increase abdominal pressure. Gaviscon Double Strength tablets, 1—2 tablets chewed as required, up to four times daily, after meals and half an hour before bed. Aluminium hydroxide tablets are an alternative antacid that are fully subsidised, but do not contain an anti-foaming agent.
Prescribe Alu-tab mg tablets, one tablet, up to four times daily, between meals and at bedtime. H 2 -receptor antagonists are second-line for patients with GORD Patients with mild symptoms who have not responded to a four to six week trial with a PPI may be offered an H 2 -receptor antagonist as an alternative, e. Reflux disease: Gastro-oesophageal reflux disease in adults. Victoria: GESA Available from: www. Epidemiology of reflux symptoms and GORD.
Best Pract Res Clin Gastroenterol ;— Pathophysiology of gastroesophageal reflux disease. Dutta U, Moayyedi P. Management of reflux-related symptoms. Drugs, the most common medical intervention, are an important part of medical care for older people. Without drugs, many older people would function less well or die at an earlier age.
Delayed emptying of the stomach for example, due to diabetes or use of opioids can also worsen reflux. Heartburn a burning pain behind the breastbone is the most obvious symptom of gastroesophageal reflux. Heartburn may be accompanied by regurgitation Regurgitation and Rumination Regurgitation is the spitting up of food from the esophagus or stomach without nausea or forceful contractions of the abdominal muscles.
Rumination is regurgitation with no apparent physical If stomach contents reach the mouth, they sometimes cause sore throat, hoarseness, cough, or a sensation of a lump in the throat Lump in Throat Some people feel as if they have a lump or mass in their throat when no mass is actually there.
If this sensation is unrelated to swallowing, it is termed globus sensation, or globus hystericus People who have longstanding heartburn sometimes develop difficulty swallowing dysphagia Difficulty Swallowing Some people have difficulty swallowing dysphagia.
People feel as though food or liquids become Abnormal cells in the esophagus that may become cancerous see Esophageal Cancer Esophageal Cancer Esophageal cancers develop in the cells that line the wall of the esophagus the tube that connects the throat to the stomach. Tobacco and alcohol use, human papillomavirus infections, and Inflammation of the esophagus esophagitis or erosive esophagitis causes symptoms typical of gastroesophageal reflux disease but perhaps more severe.
It also may cause pain with swallowing odynophagia. Some people have bleeding that is usually slight but can be massive. The blood may be vomited up or may pass through the digestive tract, resulting in the passage of dark, tarry stools melena or bright red blood, if the bleeding is heavy enough. Mild bleeding over a long period of time can cause iron deficiency anemia Iron Deficiency Anemia Iron deficiency anemia results from low or depleted stores of iron, which is needed to produce red blood cells.
Excessive bleeding is the most common cause. People may be weak, short of breath Esophageal ulcers are open sores on the lining of the esophagus.
They can cause chest pain upon swallowing that is usually located behind the breastbone or just below it, similar to the location of heartburn. Narrowing stricture of the esophagus caused by reflux makes swallowing solid foods increasingly more difficult. Reflux may cause the esophagus to become narrow. This photo also shows ulcers or open sores arrows above a narrowing stricture of the esophagus.
Prolonged irritation causes the cells lining the esophagus to change, which results in a condition called Barrett esophagus. Changes may occur without symptoms. These abnormal cells are precancerous and can sometimes progress to cancer. Repeated backflow of stomach acid reflux may cause the cells in the esophagus to change and become precancerous.
In this photo, the red tongue-shaped areas arrows are examples of these changes. When symptoms point to the diagnosis of GERD, treatment can be started without testing. Gastroesophageal reflux disease GERD is a chronic condition that affects nearly 20 percent of American adults. People with GERD spend billions on over-the-counter and prescription medications to combat painful heartburn. While most people experience occasional heartburn, also known as gastroesophageal reflux, GERD is a chronic condition with symptoms that can occur daily.
But can treating it reverse or at least reduce the damage caused by GERD? When a person swallows, a complex set of muscles near the mouth and tongue work with the epiglottis to close off the windpipe to protect the lungs and move the food into the esophagus.
The esophagus is the narrow tube connecting the throat to the stomach. At the bottom of the esophagus is a ring of muscles known as the lower esophageal sphincter LES. A healthy LES relaxes enough to allow proper movement of food from the esophagus into the stomach.
This can cause a painful burning sensation in the mid-abdomen, chest, and throat. This means the sensitive esophageal tissue may be injured over time. The acid often also backs up into the mouth, damaging other structures along the way. Sometimes the acid ends up being aspirated into the windpipe and lungs, causing problems there as well. Symptoms of GERD can be serious, especially in older people. They may include a severely inflamed esophagus and difficulty swallowing.
Acid irritation and inflammation can injure the esophagus over time, creating a condition known as erosive esophagitis. People who are obese, especially obese white men, are at the greatest risk of developing erosive esophagitis.
Some people with the condition experience bleeding. This can be seen in dark-colored stools, as well as vomit that looks bloody or like coffee grounds. The characteristic white plaques, which are. A two centimeter submucosal lesion arising from muscularis mucosae is identified in the distal esophagus. Please add info endoscopy-campus. Skip to content suchen. Generic filters Hidden label. Hidden label.
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