Running head: GASTRO ESOPHAGAEL REFLUX 1
GASTRO ESOPHAGAEL REFLUX DISEASE
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GERD differential diagnosis
Some of the differential diagnosis of the Gastroesophageal reflux disease include
Cardiac etiology/CAD
This condition must be ruled out before considering the GERD diagnosis especially in people with chest pains. Cardiac chest pains can be substernal and relieved by rest. Exercise stress testing may show abnormal signs.
Functional esophageal disorder/ functional heartburn
This condition has no differentiating symptoms or signs. Normal esophageal pH differentiates the functional heartburn and nonerosive GERD. The alternative can be the normal impedance-pH study. These studies are done on patients who do not respond well to proton-pump inhibitor therapy.
Achalasia
One of the differentiating symptoms of this condition is that dysphagia is normally prominent. Investigations done on the disease indicate that the esophageal manometry is consistent and abnormal.
Biliary colic
Some of the differentiating symptoms include epigastric pain which increases with intensity and can last a couple of hours. An ultrasound done on the victim can indicate gallstones.
Nuclear dyspepsia
The differentiating symptoms of the condition include; recurring upper abdominal pain which lasts for more than three months. Nausea and bloating without an abnormal structural cause. There are no definitive differentiating tests for this condition since there is no esophagitis in endoscopy for both nonnuclear dyspepsia and nonerosive GERD.
Peptic ulcer disease
The condition indicates some of the differentiating symptoms such as, burning pain in the epigastrium, which often occurs as a result of hunger or hours after meals. The pain is usually severe and can only be relieved by food and antacids. Tests done on the endoscopy indicate ulcer. Furthermore, testing for Helicobacter pylori disease is always positive, even though it is not diagnostic.
Proton pump inhibitor-responsive esophageal eosinophilia
This condition is regarded to be distinct from eosinophilia esophagitis, but this does not imply that it is a sign of GERD. The condition should only be diagnosed if the victim has histologic findings and esophageal symptoms of esophageal eosinophilia but show a histologic and symptomatic response to proton-pump inhibition.
Malignancy
Often common in older adults who demonstrate alarm symptoms such as progressive dysphagia, anemia, melena, hematemesis, involuntary weight loss and persistent vomiting. Laboratory tests might show anemia.
Other laboratory tests that can be used to confirm GERD include;
Ambulatory pH monitoring
These tests are used to detect the presence or absence of reflux of gastric contents and is one of the most efficient ways to measure the exact amount of time the reflux is present.
Barium radiography
This is one of the most sensitive lab tests which is done to detect esophageal structures which is essential in evaluating patients who have symptoms of dysphagia.
Esophageal manometry
These tests are meant to measure the muscle pressure in the lower esophagus although it has a very insignificant role in GERD diagnosis.
Best medication for treatment of GERD and why?
The best medication for the treatment of GERD is the lifestyle change and home remedies. This type of treatment is far much better than surgeries and medications because it generally improves the patient’s overall lifestyle and can prevent the occurrence of other lifestyle diseases. These steps involve remedies without the use of medications and surgeries. Some of the home remedies and lifestyle modifications include;
Weight loss – it would be important to reduce excess weight especially in the excess abdominal weight which may result in acid rise up to the esophagus.
Wearing loose fitting cloths can also reduce pressure on the abdomen.
Avoiding foods that cause heartburn-such foods may include, alcohol, fatty foods, caffeine, chocolate, fried foods, garlic, mint, tomatoes, onions, citrus fruits and tomato-based sources.
Quit smoking- smoking makes it difficult for the esophageal sphincter to function effectively.
A patient can also be advised to change eating habits such as, try to eat smaller meals, chewing thoroughly and eating your food slowly.
References
DeVault, K. R., & Castell, D. O. (1999). Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. The American journal of gastroenterology, 94(6), 1434.