Esophagus

Gastoeneterology / Hepatology‎ > ‎

DYSPHAGIA: 3 questions needs to be defined:

Location of Dysphagia

Orophyrangeal or
Esophageal;

If Esophageal mechanism of dysphagia-

Mechnical (only solid) or
Motor (Both Solid and/or Liquid) -

Then characteristics of dysphagia

progressive or
intermittent or non-progressive

Causes of Dysphagia MKSAP 16 GI Table 1

Etiology of Dysphagia : Diagnostic Approach (Up-to-date)

Additional References:

Approach to the patient with esophageal dysphagia (Up-to-date)

GERD: Esophageal vs. Extra-esophageal Syndromes (with associated esophageal symptoms)

Alarm symptoms (dysphagia, anemia, weight loss, vomiting)

Present - Refer to GI for EGD
Absent - Therapeutic Trial with PPI and dietary rec. - If no or incomplete response, refer to Up-to-date algorithm

Severe GERD

What is the most effective treatment for severe gastro-oesophageal reflux disease? BMJ 2015
Clinical Pearls:

PPI should preferably be given before the first meal of the day ( when H-K-ATPase present in parietal cell is greatest after a prolonged fast, and parietal cells are stimulated post-prandially to secrete acid)
PPI should not be given with other acid suppresants.
PPI can be given twice a day (before evening meal) if needed and is useful especially in the first few days
PPI has its maximum effect (around 65%) after 5 days; normal acid secretion is restored after 24 - 48 hr
H2B work best for PRN (due to rapid onset action) ; PPI are not good for PRN dosing

Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease AJG 2013

GERD Initial Management Algorithm (Figure 6, MKSAP 16)

Management algorithm of GERD patient who failed PPI once daily Up-To-Date
GERD Lancet 2013 (LA Classification of reflux esophagitis)
GERD Lancet 2013 (Algorithm for alarm or refractory symptoms)