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atypical GERD |
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atypical GERD Internal medicine An atypical presentation of GERD which affects up to 30% of Pts with classic GERD Clinical 1. Lungs–asthma, cough, chronic bronchitis, pulmonary fibrosis, pneumonia; 2. ENT–laryngitis, sinusitis,
hoarseness, vocal nodules, globus hystericus; 3. Others–noncardiac chest pain, dental erosion, hiccups Diagnosis Dx of exclusion; Hx of severe chest pain–postprandial or nocturnal; endoscopic esophagitis, < 50% of Pts; esophageal pH
monitoring–85% sensitivity; test of therapy Management Unlike classic GERD, atypical GERD requires longer treatment, is less responsive to therapy; high-dose proton pump inhibitor therapy for 12 wks; nonresponders may require fundoplication.
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It is extremely helpful in patients with atypical GERD symptoms, such as noncardiac chest pain, laryngitis, asthma, and chronic cough, to determine whether these symptoms are due to GERD. 6-20) GERD patients who did not have heartburn were considered to have atypical GERD, and it was the prevailing belief that laryngopharyngeal symptoms were not the result of actual reflux of gastric contents into the throat, but rather the result of vagally mediated reflexes. |
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