Curbside Consultation in GERD
49 Clinical Questions
Herausgeber: Katz, Philip
Curbside Consultation in GERD
49 Clinical Questions
Herausgeber: Katz, Philip
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Curbside Consultation in GERD: 49 Clinical Questions provides quick and direct answers to the thorny questions commonly posed during a "curbside consultation" between colleagues.
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Curbside Consultation in GERD: 49 Clinical Questions provides quick and direct answers to the thorny questions commonly posed during a "curbside consultation" between colleagues.
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Produktdetails
- Produktdetails
- Verlag: CRC Press
- Seitenzahl: 190
- Erscheinungstermin: 15. April 2008
- Englisch
- Abmessung: 254mm x 178mm x 10mm
- Gewicht: 369g
- ISBN-13: 9781556428180
- ISBN-10: 1556428189
- Artikelnr.: 22888221
- Herstellerkennzeichnung
- Books on Demand GmbH
- In de Tarpen 42
- 22848 Norderstedt
- info@bod.de
- 040 53433511
- Verlag: CRC Press
- Seitenzahl: 190
- Erscheinungstermin: 15. April 2008
- Englisch
- Abmessung: 254mm x 178mm x 10mm
- Gewicht: 369g
- ISBN-13: 9781556428180
- ISBN-10: 1556428189
- Artikelnr.: 22888221
- Herstellerkennzeichnung
- Books on Demand GmbH
- In de Tarpen 42
- 22848 Norderstedt
- info@bod.de
- 040 53433511
Philip O. Katz, MD, FACG is Chairman of the Division of Gastroenterology at Albert Einstein Medical Center and Clinical Professor of Medicine at Jefferson Medical College in Philadelphia, PA. He is also Associate Program Director of the Department of Medicine at Albert Einstein Medical Center. Dr. Katz received his medical degree from the Bowman Gray School of Medicine at Wake Forest University in Winston-Salem, NC. He served his residency and chief residency in internal medicine, followed by a fellowship in gastroenterology at the Bowman Gray School of Medicine. He completed a faculty development fellowship at Johns Hopkins University in Baltimore, MD. He is board certified in internal medicine and gastroenterology. Dr. Katz is currently Vice President of the American College of Gastroenterology and is a member of the American Gastroenterological Association and the American Society for Gastrointestinal Endoscopy. A recognized national authority on esophageal disease, Dr. Katz's research interests include all aspects of gastroesophageal reflux disease, including nocturnal recovery of gastric acid secretion during proton pump inhibitor therapy and esophageal pain perception. Dr. Katz is a practicing clinician with active teaching and editorial positions. In addition to lecturing on many gastroenterology-related topics, Dr. Katz is Associate Editor for Reviews in Gastrointestinal Disorders (Med Reviews) and an editorial reviewer for Annals of Internal Medicine, American Journal of Gastroenterology, Gastroenterology, and Digestive Diseases and Sciences. He has contributed to the publication of over 120 peer-reviewed papers as well as numerous abstracts, books, book chapters, and monographs.
Contents Dedication Acknowledgments About the Author Question 1. Mr. Smith
Is a 52-Year-Old Man Who Has Never Been on PPI Therapy. After an ED visit
for Chest Pain, He Is Found to Have Grade D Erosive Esophagitis. I Have
Started Omeprazole 40 mg Daily, and His Symptoms Have Resolved. Does He
Need a Follow-Up Endoscopy? Question 2.What Are the Indications for
Endoscopy in Patients With Classic Gastro-esophageal Reflux Disease?
Question 3. Ms. Jones Is a 45-Year-Old School Teacher Who Has Reflux
Controlled on BID Omeprazole. She Does Not Like to Take Medications and
Would Like to Consider Fundoplication. Is This Reasonable Given Her Good
Response to PPI therapy? Question 4. How Important Is Surgeon Selection in
Antireflux Surgery? Is the Laparoscopic Approach Now Standard of Care for a
Nissen Fundoplication? Question 5. A 55-Year-Old Man Is Referred for
Evaluation for Antireflux Surgery. What Is the Appropriate Preoperative
Evaluation of This Patient? Is Esophageal Function Testing (Manometry)
Needed? Question 6.What Are the Indications for 24-Hour Ambulatory pH
Monitoring? Which of My Patients Should Have This Study \u201cOn
Medications\u201d Versus \u201cOff Medications\u201d? Question 7.My Patient
Has Dysphonia That I Believe is Due to Reflux, but Her 24-Hour pH Probe on
BID Pantoprazole Was Negative. Are There Other Reflux Tests That I Should
Consider? Question 8. Mr. Jones Has Classic Reflux Symptoms Even While
Taking BID Esomeprazole. I Have Considered a pH Probe With Impedance to
Document Non-Acid Reflux, but I Am Wondering What Therapy I Can Provide
Even if This Test Is Conclusive? Question 9. What Is the Role of Dietary
Modification in the Management of Patients with Reflux? Question 10. Are
Any Specific Lifestyle Changes Better Than Others? Question 11. What Is the
Optimal Use of Over-the-Counter Antacids and H2 Receptor Antagonists in the
Management of Reflux Patients? Question 12.Dr. Smith Suggested That I Add
Ranitidine 150 mg at Bedtime to a Regimen of BID Esomeprazole. Is There Any
Evidence That This Helps Patients With Symptoms of GERD? Question 13.Is an
Empiric Trial of PPI Therapy Efficacious in Patients With Suspected GERD?
In What Circumstances? Question 14.What Are the Choices for Therapeutic
Trials (Doses and Length of Trial) in Patients with Reflux Symptoms? Does
This Mean That You Stop PPIs if They Are Not Effective? Question 15. What
Is the Mechanism of Action of Antisecretory Therapy for GERD? Question 16.
A Pharmaceutical Rep Tells Me that PPIs Often Fail Because Patients Do Not
Take Them as Directed. Is It True That Some PPIs Need to Be Given Before
Meals, but Others Do Not? Question 17. What Are the So-Called
Extraesophageal Manifestations of GERD? Question 18. Is the Diagnostic
Approach to GERD Patients Different Than Patients With Typical Symptoms of
Heartburn and Regurgitation? Question 19.Are the Therapeutic Choices
Different for These Patients and, If So, How? Question 20. A Patient With
Long-Standing GERD Is Asymptomatic on a Once-Daily PPI. He Wants to Know if
He Needs to Take His Medication \u201cfor the Rest of His Life.\u201d
Address the Long-Term Maintenance Therapy for GERD. Question 21.What Is the
Role of an On-Demand Treatment in Maintenance? Who Is the Best Candidate?
Question 22. What Is the Role of Prokinetic Agents in the Treatment of
GERD, and How Do I Know Which One to Use? Question 23. A Patient With
Classic GERD Symptoms Is Unhappy With His Current Treatment. What Is the
Approach to a Patient With Continued Symptoms on Once-Daily PPI? On
Twice-Daily Proton Pump Inhibitor? Question 24. What Are the Short- and
Long-Term Risks of Proton Pump Inhibitor Therapy? Are Any Risks of Clinical
Importance? Question 25. A 42-Year-Old Man Who Does Not Use Tobacco or
Alcohol but Has Chronic Reflux Presents for Evaluation and Wants to Know If
He Is at Risk for Esophageal Cancer. What Do I Tell Him? Does His Risk
Change if His Symptoms Are Effectively Relieved With PPI Therapy? Question
26.Who Is at Risk for Barrett\u2019s Esophagus? Do African Americans Need
to Worry About Barrett\u2019s Esophagus? Question 27.Should Patients Be
Screened for Barrett\u2019s? Are There Patients Who Need Not Be Screened?
Question 28. Are the Pharmacologic Options for Barrett\u2019s Different
from GERD? Have PPIs Been Shown to Have Any Effect on Barrett\u2019s
(Either Prevention or Therapy)? Question 29. Mr. Smith Has No Reflux
Symptoms but Underwent Upper Endoscopy as Part of a Celiac Sprue
Evaluation. He Was Found to Have a 5-mm Segment of Columnar-Lined Esophagus
Without Nodularity. Biopsies Showed Intestinal Metaplasia but No Dysplasia.
What Is the Appropriate Follow-Up? Question 30. Should Endoscopic
Surveillance Be Performed in a Patient with Barrett\u2019s? If So, How?
Question 31.What Are the Management Options for Dysplasia in Patients With
Barrett\u2019s Esophagus, Specifically High-Grade Dysplasia? Question 32.A
Patient With Long-Standing GERD Does Not Wish to Take Long-Term Medical
Therapy and Inquires About the Options for Treatment. He Wonders if There
Is Something He Can Do Other Than Antireflux Surgery? Is There a Role for
Endoscopic Therapy for GERD? Question 33.Are There Differences Among PPIs
in Clinical Practice? Should I Ever Consider Switching Among Different PPIs
for Patients Who Fail to Respond? Question 34. Is There a Role for a
Combination of Proton Pump Inhibitors and H2 Receptor Antagonists in a
Patient with GERD? Question 35.What Is Nocturnal Acid Breakthrough, and
What Is Its Clinical Importance? Is Zegerid Really Any More Effective in
This Group? Question 36.What Is the Role of Helicobacter pylori in GERD? Do
All Patients with GERD Need to Be Tested for Helicobacter pylori? Question
37.Ms. Smith Went to the ER with Chest Pain That Was Determined to Be
Noncardiac. Serologies for H. pylori Were Found to Be Positive in the ED. I
Have Considered Treating Her but Have Heard That This May Worsen Her
Reflux. What Should I Do? Question 38. Can Medical Therapy Alter the
Natural History of Barrett\u2019s Eso-phagus? Question 39.Can Antireflux
Surgery Alter the Natural History of Barrett\u2019s Esophagus? Question
40.Do Either Medical Therapy or Antireflux Surgery Reduce the Risk of or
Prevent the Development of Esophageal Cancer? Question 41. How Does
Pregnancy Affect GERD? Is GERD in Pregnancy a Risk for Long-Term Reflux?
Question 42. What Are the Treatment Options for GERD in Pregnancy? Question
43.A 45-Year-Old Gentleman Comes to You Following a Laparoscopic Nissen
Fundoplication 5 Years Ago. He Now Has Recurrent GERD Symptoms. How Common
Is This? Question 44. What Is the Association of Obesity and GERD? Question
45. Is Bariatric Surgery Good for Reflux? Question 46. Is There a Gender
Difference in Reflux Disease? Does This Affect Treatment? Question 47. What
Are the Ethnic Differences in GERD Presentations? Question 48.Which
Patients With Barrett\u2019s Should Be Referred for Photodynamic Therapy?
Question 49. I Know That Reflux and Eosinophilic Esophagitis Can Lead to
Dysphagia and Eosinophils on Esophageal Biopsy. How Do I Differentiate
These Two Diseases? Index
Is a 52-Year-Old Man Who Has Never Been on PPI Therapy. After an ED visit
for Chest Pain, He Is Found to Have Grade D Erosive Esophagitis. I Have
Started Omeprazole 40 mg Daily, and His Symptoms Have Resolved. Does He
Need a Follow-Up Endoscopy? Question 2.What Are the Indications for
Endoscopy in Patients With Classic Gastro-esophageal Reflux Disease?
Question 3. Ms. Jones Is a 45-Year-Old School Teacher Who Has Reflux
Controlled on BID Omeprazole. She Does Not Like to Take Medications and
Would Like to Consider Fundoplication. Is This Reasonable Given Her Good
Response to PPI therapy? Question 4. How Important Is Surgeon Selection in
Antireflux Surgery? Is the Laparoscopic Approach Now Standard of Care for a
Nissen Fundoplication? Question 5. A 55-Year-Old Man Is Referred for
Evaluation for Antireflux Surgery. What Is the Appropriate Preoperative
Evaluation of This Patient? Is Esophageal Function Testing (Manometry)
Needed? Question 6.What Are the Indications for 24-Hour Ambulatory pH
Monitoring? Which of My Patients Should Have This Study \u201cOn
Medications\u201d Versus \u201cOff Medications\u201d? Question 7.My Patient
Has Dysphonia That I Believe is Due to Reflux, but Her 24-Hour pH Probe on
BID Pantoprazole Was Negative. Are There Other Reflux Tests That I Should
Consider? Question 8. Mr. Jones Has Classic Reflux Symptoms Even While
Taking BID Esomeprazole. I Have Considered a pH Probe With Impedance to
Document Non-Acid Reflux, but I Am Wondering What Therapy I Can Provide
Even if This Test Is Conclusive? Question 9. What Is the Role of Dietary
Modification in the Management of Patients with Reflux? Question 10. Are
Any Specific Lifestyle Changes Better Than Others? Question 11. What Is the
Optimal Use of Over-the-Counter Antacids and H2 Receptor Antagonists in the
Management of Reflux Patients? Question 12.Dr. Smith Suggested That I Add
Ranitidine 150 mg at Bedtime to a Regimen of BID Esomeprazole. Is There Any
Evidence That This Helps Patients With Symptoms of GERD? Question 13.Is an
Empiric Trial of PPI Therapy Efficacious in Patients With Suspected GERD?
In What Circumstances? Question 14.What Are the Choices for Therapeutic
Trials (Doses and Length of Trial) in Patients with Reflux Symptoms? Does
This Mean That You Stop PPIs if They Are Not Effective? Question 15. What
Is the Mechanism of Action of Antisecretory Therapy for GERD? Question 16.
A Pharmaceutical Rep Tells Me that PPIs Often Fail Because Patients Do Not
Take Them as Directed. Is It True That Some PPIs Need to Be Given Before
Meals, but Others Do Not? Question 17. What Are the So-Called
Extraesophageal Manifestations of GERD? Question 18. Is the Diagnostic
Approach to GERD Patients Different Than Patients With Typical Symptoms of
Heartburn and Regurgitation? Question 19.Are the Therapeutic Choices
Different for These Patients and, If So, How? Question 20. A Patient With
Long-Standing GERD Is Asymptomatic on a Once-Daily PPI. He Wants to Know if
He Needs to Take His Medication \u201cfor the Rest of His Life.\u201d
Address the Long-Term Maintenance Therapy for GERD. Question 21.What Is the
Role of an On-Demand Treatment in Maintenance? Who Is the Best Candidate?
Question 22. What Is the Role of Prokinetic Agents in the Treatment of
GERD, and How Do I Know Which One to Use? Question 23. A Patient With
Classic GERD Symptoms Is Unhappy With His Current Treatment. What Is the
Approach to a Patient With Continued Symptoms on Once-Daily PPI? On
Twice-Daily Proton Pump Inhibitor? Question 24. What Are the Short- and
Long-Term Risks of Proton Pump Inhibitor Therapy? Are Any Risks of Clinical
Importance? Question 25. A 42-Year-Old Man Who Does Not Use Tobacco or
Alcohol but Has Chronic Reflux Presents for Evaluation and Wants to Know If
He Is at Risk for Esophageal Cancer. What Do I Tell Him? Does His Risk
Change if His Symptoms Are Effectively Relieved With PPI Therapy? Question
26.Who Is at Risk for Barrett\u2019s Esophagus? Do African Americans Need
to Worry About Barrett\u2019s Esophagus? Question 27.Should Patients Be
Screened for Barrett\u2019s? Are There Patients Who Need Not Be Screened?
Question 28. Are the Pharmacologic Options for Barrett\u2019s Different
from GERD? Have PPIs Been Shown to Have Any Effect on Barrett\u2019s
(Either Prevention or Therapy)? Question 29. Mr. Smith Has No Reflux
Symptoms but Underwent Upper Endoscopy as Part of a Celiac Sprue
Evaluation. He Was Found to Have a 5-mm Segment of Columnar-Lined Esophagus
Without Nodularity. Biopsies Showed Intestinal Metaplasia but No Dysplasia.
What Is the Appropriate Follow-Up? Question 30. Should Endoscopic
Surveillance Be Performed in a Patient with Barrett\u2019s? If So, How?
Question 31.What Are the Management Options for Dysplasia in Patients With
Barrett\u2019s Esophagus, Specifically High-Grade Dysplasia? Question 32.A
Patient With Long-Standing GERD Does Not Wish to Take Long-Term Medical
Therapy and Inquires About the Options for Treatment. He Wonders if There
Is Something He Can Do Other Than Antireflux Surgery? Is There a Role for
Endoscopic Therapy for GERD? Question 33.Are There Differences Among PPIs
in Clinical Practice? Should I Ever Consider Switching Among Different PPIs
for Patients Who Fail to Respond? Question 34. Is There a Role for a
Combination of Proton Pump Inhibitors and H2 Receptor Antagonists in a
Patient with GERD? Question 35.What Is Nocturnal Acid Breakthrough, and
What Is Its Clinical Importance? Is Zegerid Really Any More Effective in
This Group? Question 36.What Is the Role of Helicobacter pylori in GERD? Do
All Patients with GERD Need to Be Tested for Helicobacter pylori? Question
37.Ms. Smith Went to the ER with Chest Pain That Was Determined to Be
Noncardiac. Serologies for H. pylori Were Found to Be Positive in the ED. I
Have Considered Treating Her but Have Heard That This May Worsen Her
Reflux. What Should I Do? Question 38. Can Medical Therapy Alter the
Natural History of Barrett\u2019s Eso-phagus? Question 39.Can Antireflux
Surgery Alter the Natural History of Barrett\u2019s Esophagus? Question
40.Do Either Medical Therapy or Antireflux Surgery Reduce the Risk of or
Prevent the Development of Esophageal Cancer? Question 41. How Does
Pregnancy Affect GERD? Is GERD in Pregnancy a Risk for Long-Term Reflux?
Question 42. What Are the Treatment Options for GERD in Pregnancy? Question
43.A 45-Year-Old Gentleman Comes to You Following a Laparoscopic Nissen
Fundoplication 5 Years Ago. He Now Has Recurrent GERD Symptoms. How Common
Is This? Question 44. What Is the Association of Obesity and GERD? Question
45. Is Bariatric Surgery Good for Reflux? Question 46. Is There a Gender
Difference in Reflux Disease? Does This Affect Treatment? Question 47. What
Are the Ethnic Differences in GERD Presentations? Question 48.Which
Patients With Barrett\u2019s Should Be Referred for Photodynamic Therapy?
Question 49. I Know That Reflux and Eosinophilic Esophagitis Can Lead to
Dysphagia and Eosinophils on Esophageal Biopsy. How Do I Differentiate
These Two Diseases? Index
Contents Dedication Acknowledgments About the Author Question 1. Mr. Smith
Is a 52-Year-Old Man Who Has Never Been on PPI Therapy. After an ED visit
for Chest Pain, He Is Found to Have Grade D Erosive Esophagitis. I Have
Started Omeprazole 40 mg Daily, and His Symptoms Have Resolved. Does He
Need a Follow-Up Endoscopy? Question 2.What Are the Indications for
Endoscopy in Patients With Classic Gastro-esophageal Reflux Disease?
Question 3. Ms. Jones Is a 45-Year-Old School Teacher Who Has Reflux
Controlled on BID Omeprazole. She Does Not Like to Take Medications and
Would Like to Consider Fundoplication. Is This Reasonable Given Her Good
Response to PPI therapy? Question 4. How Important Is Surgeon Selection in
Antireflux Surgery? Is the Laparoscopic Approach Now Standard of Care for a
Nissen Fundoplication? Question 5. A 55-Year-Old Man Is Referred for
Evaluation for Antireflux Surgery. What Is the Appropriate Preoperative
Evaluation of This Patient? Is Esophageal Function Testing (Manometry)
Needed? Question 6.What Are the Indications for 24-Hour Ambulatory pH
Monitoring? Which of My Patients Should Have This Study \u201cOn
Medications\u201d Versus \u201cOff Medications\u201d? Question 7.My Patient
Has Dysphonia That I Believe is Due to Reflux, but Her 24-Hour pH Probe on
BID Pantoprazole Was Negative. Are There Other Reflux Tests That I Should
Consider? Question 8. Mr. Jones Has Classic Reflux Symptoms Even While
Taking BID Esomeprazole. I Have Considered a pH Probe With Impedance to
Document Non-Acid Reflux, but I Am Wondering What Therapy I Can Provide
Even if This Test Is Conclusive? Question 9. What Is the Role of Dietary
Modification in the Management of Patients with Reflux? Question 10. Are
Any Specific Lifestyle Changes Better Than Others? Question 11. What Is the
Optimal Use of Over-the-Counter Antacids and H2 Receptor Antagonists in the
Management of Reflux Patients? Question 12.Dr. Smith Suggested That I Add
Ranitidine 150 mg at Bedtime to a Regimen of BID Esomeprazole. Is There Any
Evidence That This Helps Patients With Symptoms of GERD? Question 13.Is an
Empiric Trial of PPI Therapy Efficacious in Patients With Suspected GERD?
In What Circumstances? Question 14.What Are the Choices for Therapeutic
Trials (Doses and Length of Trial) in Patients with Reflux Symptoms? Does
This Mean That You Stop PPIs if They Are Not Effective? Question 15. What
Is the Mechanism of Action of Antisecretory Therapy for GERD? Question 16.
A Pharmaceutical Rep Tells Me that PPIs Often Fail Because Patients Do Not
Take Them as Directed. Is It True That Some PPIs Need to Be Given Before
Meals, but Others Do Not? Question 17. What Are the So-Called
Extraesophageal Manifestations of GERD? Question 18. Is the Diagnostic
Approach to GERD Patients Different Than Patients With Typical Symptoms of
Heartburn and Regurgitation? Question 19.Are the Therapeutic Choices
Different for These Patients and, If So, How? Question 20. A Patient With
Long-Standing GERD Is Asymptomatic on a Once-Daily PPI. He Wants to Know if
He Needs to Take His Medication \u201cfor the Rest of His Life.\u201d
Address the Long-Term Maintenance Therapy for GERD. Question 21.What Is the
Role of an On-Demand Treatment in Maintenance? Who Is the Best Candidate?
Question 22. What Is the Role of Prokinetic Agents in the Treatment of
GERD, and How Do I Know Which One to Use? Question 23. A Patient With
Classic GERD Symptoms Is Unhappy With His Current Treatment. What Is the
Approach to a Patient With Continued Symptoms on Once-Daily PPI? On
Twice-Daily Proton Pump Inhibitor? Question 24. What Are the Short- and
Long-Term Risks of Proton Pump Inhibitor Therapy? Are Any Risks of Clinical
Importance? Question 25. A 42-Year-Old Man Who Does Not Use Tobacco or
Alcohol but Has Chronic Reflux Presents for Evaluation and Wants to Know If
He Is at Risk for Esophageal Cancer. What Do I Tell Him? Does His Risk
Change if His Symptoms Are Effectively Relieved With PPI Therapy? Question
26.Who Is at Risk for Barrett\u2019s Esophagus? Do African Americans Need
to Worry About Barrett\u2019s Esophagus? Question 27.Should Patients Be
Screened for Barrett\u2019s? Are There Patients Who Need Not Be Screened?
Question 28. Are the Pharmacologic Options for Barrett\u2019s Different
from GERD? Have PPIs Been Shown to Have Any Effect on Barrett\u2019s
(Either Prevention or Therapy)? Question 29. Mr. Smith Has No Reflux
Symptoms but Underwent Upper Endoscopy as Part of a Celiac Sprue
Evaluation. He Was Found to Have a 5-mm Segment of Columnar-Lined Esophagus
Without Nodularity. Biopsies Showed Intestinal Metaplasia but No Dysplasia.
What Is the Appropriate Follow-Up? Question 30. Should Endoscopic
Surveillance Be Performed in a Patient with Barrett\u2019s? If So, How?
Question 31.What Are the Management Options for Dysplasia in Patients With
Barrett\u2019s Esophagus, Specifically High-Grade Dysplasia? Question 32.A
Patient With Long-Standing GERD Does Not Wish to Take Long-Term Medical
Therapy and Inquires About the Options for Treatment. He Wonders if There
Is Something He Can Do Other Than Antireflux Surgery? Is There a Role for
Endoscopic Therapy for GERD? Question 33.Are There Differences Among PPIs
in Clinical Practice? Should I Ever Consider Switching Among Different PPIs
for Patients Who Fail to Respond? Question 34. Is There a Role for a
Combination of Proton Pump Inhibitors and H2 Receptor Antagonists in a
Patient with GERD? Question 35.What Is Nocturnal Acid Breakthrough, and
What Is Its Clinical Importance? Is Zegerid Really Any More Effective in
This Group? Question 36.What Is the Role of Helicobacter pylori in GERD? Do
All Patients with GERD Need to Be Tested for Helicobacter pylori? Question
37.Ms. Smith Went to the ER with Chest Pain That Was Determined to Be
Noncardiac. Serologies for H. pylori Were Found to Be Positive in the ED. I
Have Considered Treating Her but Have Heard That This May Worsen Her
Reflux. What Should I Do? Question 38. Can Medical Therapy Alter the
Natural History of Barrett\u2019s Eso-phagus? Question 39.Can Antireflux
Surgery Alter the Natural History of Barrett\u2019s Esophagus? Question
40.Do Either Medical Therapy or Antireflux Surgery Reduce the Risk of or
Prevent the Development of Esophageal Cancer? Question 41. How Does
Pregnancy Affect GERD? Is GERD in Pregnancy a Risk for Long-Term Reflux?
Question 42. What Are the Treatment Options for GERD in Pregnancy? Question
43.A 45-Year-Old Gentleman Comes to You Following a Laparoscopic Nissen
Fundoplication 5 Years Ago. He Now Has Recurrent GERD Symptoms. How Common
Is This? Question 44. What Is the Association of Obesity and GERD? Question
45. Is Bariatric Surgery Good for Reflux? Question 46. Is There a Gender
Difference in Reflux Disease? Does This Affect Treatment? Question 47. What
Are the Ethnic Differences in GERD Presentations? Question 48.Which
Patients With Barrett\u2019s Should Be Referred for Photodynamic Therapy?
Question 49. I Know That Reflux and Eosinophilic Esophagitis Can Lead to
Dysphagia and Eosinophils on Esophageal Biopsy. How Do I Differentiate
These Two Diseases? Index
Is a 52-Year-Old Man Who Has Never Been on PPI Therapy. After an ED visit
for Chest Pain, He Is Found to Have Grade D Erosive Esophagitis. I Have
Started Omeprazole 40 mg Daily, and His Symptoms Have Resolved. Does He
Need a Follow-Up Endoscopy? Question 2.What Are the Indications for
Endoscopy in Patients With Classic Gastro-esophageal Reflux Disease?
Question 3. Ms. Jones Is a 45-Year-Old School Teacher Who Has Reflux
Controlled on BID Omeprazole. She Does Not Like to Take Medications and
Would Like to Consider Fundoplication. Is This Reasonable Given Her Good
Response to PPI therapy? Question 4. How Important Is Surgeon Selection in
Antireflux Surgery? Is the Laparoscopic Approach Now Standard of Care for a
Nissen Fundoplication? Question 5. A 55-Year-Old Man Is Referred for
Evaluation for Antireflux Surgery. What Is the Appropriate Preoperative
Evaluation of This Patient? Is Esophageal Function Testing (Manometry)
Needed? Question 6.What Are the Indications for 24-Hour Ambulatory pH
Monitoring? Which of My Patients Should Have This Study \u201cOn
Medications\u201d Versus \u201cOff Medications\u201d? Question 7.My Patient
Has Dysphonia That I Believe is Due to Reflux, but Her 24-Hour pH Probe on
BID Pantoprazole Was Negative. Are There Other Reflux Tests That I Should
Consider? Question 8. Mr. Jones Has Classic Reflux Symptoms Even While
Taking BID Esomeprazole. I Have Considered a pH Probe With Impedance to
Document Non-Acid Reflux, but I Am Wondering What Therapy I Can Provide
Even if This Test Is Conclusive? Question 9. What Is the Role of Dietary
Modification in the Management of Patients with Reflux? Question 10. Are
Any Specific Lifestyle Changes Better Than Others? Question 11. What Is the
Optimal Use of Over-the-Counter Antacids and H2 Receptor Antagonists in the
Management of Reflux Patients? Question 12.Dr. Smith Suggested That I Add
Ranitidine 150 mg at Bedtime to a Regimen of BID Esomeprazole. Is There Any
Evidence That This Helps Patients With Symptoms of GERD? Question 13.Is an
Empiric Trial of PPI Therapy Efficacious in Patients With Suspected GERD?
In What Circumstances? Question 14.What Are the Choices for Therapeutic
Trials (Doses and Length of Trial) in Patients with Reflux Symptoms? Does
This Mean That You Stop PPIs if They Are Not Effective? Question 15. What
Is the Mechanism of Action of Antisecretory Therapy for GERD? Question 16.
A Pharmaceutical Rep Tells Me that PPIs Often Fail Because Patients Do Not
Take Them as Directed. Is It True That Some PPIs Need to Be Given Before
Meals, but Others Do Not? Question 17. What Are the So-Called
Extraesophageal Manifestations of GERD? Question 18. Is the Diagnostic
Approach to GERD Patients Different Than Patients With Typical Symptoms of
Heartburn and Regurgitation? Question 19.Are the Therapeutic Choices
Different for These Patients and, If So, How? Question 20. A Patient With
Long-Standing GERD Is Asymptomatic on a Once-Daily PPI. He Wants to Know if
He Needs to Take His Medication \u201cfor the Rest of His Life.\u201d
Address the Long-Term Maintenance Therapy for GERD. Question 21.What Is the
Role of an On-Demand Treatment in Maintenance? Who Is the Best Candidate?
Question 22. What Is the Role of Prokinetic Agents in the Treatment of
GERD, and How Do I Know Which One to Use? Question 23. A Patient With
Classic GERD Symptoms Is Unhappy With His Current Treatment. What Is the
Approach to a Patient With Continued Symptoms on Once-Daily PPI? On
Twice-Daily Proton Pump Inhibitor? Question 24. What Are the Short- and
Long-Term Risks of Proton Pump Inhibitor Therapy? Are Any Risks of Clinical
Importance? Question 25. A 42-Year-Old Man Who Does Not Use Tobacco or
Alcohol but Has Chronic Reflux Presents for Evaluation and Wants to Know If
He Is at Risk for Esophageal Cancer. What Do I Tell Him? Does His Risk
Change if His Symptoms Are Effectively Relieved With PPI Therapy? Question
26.Who Is at Risk for Barrett\u2019s Esophagus? Do African Americans Need
to Worry About Barrett\u2019s Esophagus? Question 27.Should Patients Be
Screened for Barrett\u2019s? Are There Patients Who Need Not Be Screened?
Question 28. Are the Pharmacologic Options for Barrett\u2019s Different
from GERD? Have PPIs Been Shown to Have Any Effect on Barrett\u2019s
(Either Prevention or Therapy)? Question 29. Mr. Smith Has No Reflux
Symptoms but Underwent Upper Endoscopy as Part of a Celiac Sprue
Evaluation. He Was Found to Have a 5-mm Segment of Columnar-Lined Esophagus
Without Nodularity. Biopsies Showed Intestinal Metaplasia but No Dysplasia.
What Is the Appropriate Follow-Up? Question 30. Should Endoscopic
Surveillance Be Performed in a Patient with Barrett\u2019s? If So, How?
Question 31.What Are the Management Options for Dysplasia in Patients With
Barrett\u2019s Esophagus, Specifically High-Grade Dysplasia? Question 32.A
Patient With Long-Standing GERD Does Not Wish to Take Long-Term Medical
Therapy and Inquires About the Options for Treatment. He Wonders if There
Is Something He Can Do Other Than Antireflux Surgery? Is There a Role for
Endoscopic Therapy for GERD? Question 33.Are There Differences Among PPIs
in Clinical Practice? Should I Ever Consider Switching Among Different PPIs
for Patients Who Fail to Respond? Question 34. Is There a Role for a
Combination of Proton Pump Inhibitors and H2 Receptor Antagonists in a
Patient with GERD? Question 35.What Is Nocturnal Acid Breakthrough, and
What Is Its Clinical Importance? Is Zegerid Really Any More Effective in
This Group? Question 36.What Is the Role of Helicobacter pylori in GERD? Do
All Patients with GERD Need to Be Tested for Helicobacter pylori? Question
37.Ms. Smith Went to the ER with Chest Pain That Was Determined to Be
Noncardiac. Serologies for H. pylori Were Found to Be Positive in the ED. I
Have Considered Treating Her but Have Heard That This May Worsen Her
Reflux. What Should I Do? Question 38. Can Medical Therapy Alter the
Natural History of Barrett\u2019s Eso-phagus? Question 39.Can Antireflux
Surgery Alter the Natural History of Barrett\u2019s Esophagus? Question
40.Do Either Medical Therapy or Antireflux Surgery Reduce the Risk of or
Prevent the Development of Esophageal Cancer? Question 41. How Does
Pregnancy Affect GERD? Is GERD in Pregnancy a Risk for Long-Term Reflux?
Question 42. What Are the Treatment Options for GERD in Pregnancy? Question
43.A 45-Year-Old Gentleman Comes to You Following a Laparoscopic Nissen
Fundoplication 5 Years Ago. He Now Has Recurrent GERD Symptoms. How Common
Is This? Question 44. What Is the Association of Obesity and GERD? Question
45. Is Bariatric Surgery Good for Reflux? Question 46. Is There a Gender
Difference in Reflux Disease? Does This Affect Treatment? Question 47. What
Are the Ethnic Differences in GERD Presentations? Question 48.Which
Patients With Barrett\u2019s Should Be Referred for Photodynamic Therapy?
Question 49. I Know That Reflux and Eosinophilic Esophagitis Can Lead to
Dysphagia and Eosinophils on Esophageal Biopsy. How Do I Differentiate
These Two Diseases? Index