MKSAP: 35-year-old man with persistent heartburn

Test your medicine knowledge with the  MKSAP challenge, in partnership with the American College of Physicians. A 35-year-old man is evaluated during a follow-up appointment for persistent heartburn with chronic cough. He has a 1-year history of gastroesophageal reflux disease and takes pantoprazole twice daily. He reports no nausea, vomiting, or dysphagia. Upper endoscopy performed 1 year […]Find jobs at  Careers by KevinMD.com.  Search thousands of physician, PA, NP, and CRNA jobs now.  Learn more.
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Gastroenterology Source Type: blogs

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This article reviews the current literature regarding established and proposed EE-GERD, reporting on all available options for its correct diagnosis and therapeutic management. Expert opinion: MII-pH could help to identify a hidden GERD that causes EE. Unfortunately, standard MII-pH analysis results are often unable to define this association. New parameters such as the mean nocturnal baseline impedance and post-reflux swallow-induced peristaltic wave index may have an improved diagnostic yield, but prospective studies using impedance-pH are needed. PMID: 31322443 [PubMed - as supplied by publisher]
Source: Expert Review of Gastroenterology and Hepatology - Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research
Conclusions: Successful treatment of GER-associated cough may be associated with the attenuation of neurogenic and neutrophilic inflammation. PMID: 31303089 [PubMed - as supplied by publisher]
Source: Journal of Asthma - Category: Respiratory Medicine Tags: J Asthma Source Type: research
CONCLUSION Male gender and hiatal hernia were associated with EE. Aged patients, smoking and hiatal herni a were related to severe EE. It is suggested that the risk factors for EE and non-EE types are different. Cohort studies are necessary to identify the exact mechanisms involved in each disease form.RESUMO CONTEXTO: A doen ça do refluxo gastroesofágico (DRGE) é uma das doenças digestivas mais comuns na prática médica e deve ser suspeitada de acordo com os seus sintomas clínicos, podendo ser classificada em esofagite erosiva (EE) de acordo com os achados de endoscopia. OBJ...
Source: Arquivos de Gastroenterologia - Category: Gastroenterology Source Type: research
Conclusion: The specific items on our questionnaire relating to patient characteristics, complications, and triggers of cough, represent useful tools for diagnosing the primary disease producing cough.
Source: In Vivo - Category: Research Authors: Tags: Clinical Studies Source Type: research
CONCLUSIONS: These data showed that GERD is present in a quarter of ABG patients, suggesting that hypochlorhydria not exclude per se arising of oesophageal symptoms. In ABG we found that ME is a frequent finding but its clinical relevance remains to be investigated with further studies. PMID: 30638085 [PubMed - as supplied by publisher]
Source: Scandinavian Journal of Gastroenterology - Category: Gastroenterology Tags: Scand J Gastroenterol Source Type: research
MK Abstract BACKGROUND: Many physicians insist patients lose weight before their hiatal hernia (HH) condition and related symptoms including intermittent esophageal dysphagia (IED) and gastroesophageal reflux disease (GERD) can be treated, but it is not proven that body mass index (BMI) has an impact on exercise-based treatment of HH-related symptoms. AIMS/OBJECTIVES: To investigate whether BMI has significance on IQoro® neuromuscular training (IQNT) effectiveness in treating HH-related symptoms. MATERIAL AND METHODS: Eighty-six patients with sliding HH and enduring IED and GERD symptoms, despite pr...
Source: Acta Oto-Laryngologica - Category: ENT & OMF Authors: Tags: Acta Otolaryngol Source Type: research
This study evaluated this relationship in a cohort of Sri Lankan COPD patients.Methods: A validated GORD screening questionnaire assessed frequency and severity of 7 GORD and 5 RAR symptoms, in 67 COPD patients (83.6% male, mean age (SD) 66.8 (10.2) years) and 69 comparable controls (71% male, mean age (SD) 66.2 (8.1) years). The subjects were GORD symptom positive if the composite GORD score was ≥ 12.5. Medication use, smoking history and spirometry were also recorded.Results: The mean (SD) GORD symptom score of COPD patients; 29.9 (20.6) was higher than controls; 10.6 (5.2);P
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Clinical Problems Source Type: research
Introduction: Snoring and nocturnal gastroesophageal reflux (nGER) are each associated with respiratory symptoms, but their effect combined is not known. We aimed to study the association of lung function and respiratory symptoms with snoring and nGER.Methods: We used data from the European Community Respiratory Health Survey (ECRHS) III, a cross-sectional multi-centre general population study comprising 5715 participants. Post-bronchodilator spirometry was performed, and information on respiratory, sleep and nGER symptoms was collected. Habitual snoring was defined as reporting of snoring 'loudly or disturbingly, frequent...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Sleep and control of breathing Source Type: research
It is not clear whether we should test for reflux in patients with refractory heartburn or extraesophageal reflux (EER) symptoms, such as cough, hoarseness, or asthma. Guidelines recommend testing patients by pH monitoring when they are on or off acid-suppressive therapies based on pretest probability of reflux, determined by expert consensus. However, it is not clear what constitutes a low or high pretest probability of reflux in these patients. We aimed to develop a model that clinicians can use at bedside to estimate pretest probability of abnormal reflux.
Source: Gastroenterology - Category: Gastroenterology Authors: Tags: Clinical —Alimentary Tract Source Type: research
It is not clear whether we should test for reflux in patients with refractory heartburn or extra-esophageal reflux (EER) symptoms, such as cough, hoarseness, or asthma. Guidelines recommend testing patients by pH monitoring when they are on or off acid-suppressive therapies based on pre-test probability of reflux, determined by expert consensus. However, it is not clear what constitutes a low or high pre-test probability of reflux in these patients. We aimed to develop a model that clinicians can use at bedside to estimate pre-test probability of abnormal reflux.
Source: Gastroenterology - Category: Gastroenterology Authors: Source Type: research
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