Heartburn differential diagnosis: Difference between revisions
Jump to navigation
Jump to search
Jose Loyola (talk | contribs) |
Jose Loyola (talk | contribs) |
||
| Line 30: | Line 30: | ||
|[[Symptoms]] appears with physical exertion or extreme [[stress]] | |[[Symptoms]] appears with physical exertion or extreme [[stress]] | ||
|} | |} | ||
{{familytree/start |summary=PE diagnosis Algorithm.}} {{familytree | | | | A01 |~| A02 | A01='''Classic symptoms of GERD''' <br>(heartburn and regurgitation)|A02= If there are '''warning [[signs]]*''':<br> upper [[endoscopy]] during the initial evaluation}} | |||
{{familytree | | | | |!| | | | }} | |||
{{familytree | | | | B01 | | | B01= PPI 8-week trial}} | |||
{{familytree | | |,|-|^|-|.| | }} | |||
{{familytree | | C01 | | C02 | C01= If better: [[GERD]] probable| C02= If refractory, proceed to refractory [[GERD]] algorithm}} | |||
{{familytree/end}} | |||
<nowiki>*</nowiki> [[Dysphagia]], [[bleeding]], [[anemia]], [[weight loss]] and recurrent [[vomiting]] are considered warning signs and should be investigated with [[upper endoscopy]]. | |||
{{familytree/start}} | |||
{{familytree | | | | | | | Z01 |~| Z02 | |Z01='''Treat [[GERD]]:''' <br> '''Start a 8-week course of [[PPI]]'''|Z02= If there are '''warning [[signs]]*''':<br> upper [[endoscopy]] during the initial evaluation}} | |||
{{familytree | | | | | | | |!| | | | |}} | |||
{{familytree | | | | | | | A01 | | | |A01='''Refractory [[GERD]]'''}} | |||
{{familytree | | | | | | | |!| | | | |}} | |||
{{familytree | | | | | | | B01 | | | | |B01='''Optimize [[PPI]] therapy'''}} | |||
{{familytree | | | | | | | |!| | | | |}} | |||
{{familytree | | | | | | | C01 | | | | |C01= '''No response''': <br> Exclude other etiologies}} | |||
{{familytree | | | |,|-|-|-|^|-|-|-|.|}} | |||
{{familytree | | | D01 | | | | | | D02 | |D01= '''Typical [[symptoms]]''':<BR>Upper endoscopy|D02= '''Atypical [[symptoms]]''': <br> Referral to [[ENT]], [[pulmonary]], allergy specialist}} | |||
{{familytree | | | |)|-|-|-|v|-|-|-|(| |}} | |||
{{familytree | | | E01 | | E02 | | E03 | |E01= '''Abnormal''':<br> ([[eosinophilic esophagitis]], erosive [[esophagitis]], other)<br>'''Specific treatment'''|E02= '''NORMAL'''|E03= '''Abnormal''': <br> (ENT, [[pulmonary]], or [[allergic]] disorder)<br>'''Specific treatment'''}} | |||
{{familytree | | | | | | | |!| | | | | | | | | | |}} | |||
{{familytree | | | | | | | F01 | | | | | | | | | |F01= '''REFLUX MONITORING'''}} | |||
{{familytree | | | | | |,|-|^|-|.| | | | | | | | |}} | |||
{{familytree | | | | | G01 | | G02 | | | | | | | |G01= Low pre test probability of GERD|G02= High pre test probability of [[GERD]]}} | |||
{{familytree | | | | | |!| | | |!| | | | | | | | |}} | |||
{{familytree | | | | | H01 | | H02 | | | | |H01=Test off [[medication]] with pH or impedance-pH|H02=Test on [[medication]] with impedance-pH}} | |||
{{familytree/end}} | |||
*High Risk: Men >50 years with chronic [[gastroesophageal reflux disease]] [[symptoms]] (>5 years), AND: | |||
**[[Nocturnal]] [[reflux]] [[symptoms]] | |||
**[[Hiatal hernia]] | |||
**Elevated [[body mass index]] | |||
**[[Tobacco]] use | |||
**Intra-abdominal distribution of fat | |||
* [[Angina]] / ischemia | * [[Angina]] / ischemia | ||
Revision as of 17:11, 1 September 2020
|
Heartburn Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Heartburn differential diagnosis On the Web |
|
American Roentgen Ray Society Images of Heartburn differential diagnosis |
|
Risk calculators and risk factors for Heartburn differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: José Eduardo Riceto Loyola Junior, M.D.[2]
Differentiating Heartburn from other Diseases
| Heartburn (GERD) | Angina or Heart Attack |
|---|---|
| Burning chest pain, begins at the breastbone | Tightness, pressure, squeezing, stabbing or dull pain, most often in the center |
| Pain that radiates towards the throat | Pain radiates to the shoulders, neck or arms |
| Sensation of food coming back to the mouth | Irregular or rapid heartbeat |
| Acid taste in the back of the throat | Cold sweat or clammy skin |
| Pain worsens when patient lie down or bend over | Lightheadedness, weakness, dizziness, nausea, indigestion or vomiting |
| Appears after large or spicy meal | Shortness of breath |
| Symptoms appears with physical exertion or extreme stress |
| Classic symptoms of GERD (heartburn and regurgitation) | If there are warning signs*: upper endoscopy during the initial evaluation | ||||||||||||||||||
| PPI 8-week trial | |||||||||||||||||||
| If better: GERD probable | If refractory, proceed to refractory GERD algorithm | ||||||||||||||||||
* Dysphagia, bleeding, anemia, weight loss and recurrent vomiting are considered warning signs and should be investigated with upper endoscopy.
| Treat GERD: Start a 8-week course of PPI | If there are warning signs*: upper endoscopy during the initial evaluation | ||||||||||||||||||||||||||||||||||||
| Refractory GERD | |||||||||||||||||||||||||||||||||||||
| Optimize PPI therapy | |||||||||||||||||||||||||||||||||||||
| No response: Exclude other etiologies | |||||||||||||||||||||||||||||||||||||
| Typical symptoms: Upper endoscopy | Atypical symptoms: Referral to ENT, pulmonary, allergy specialist | ||||||||||||||||||||||||||||||||||||
| Abnormal: (eosinophilic esophagitis, erosive esophagitis, other) Specific treatment | NORMAL | Abnormal: (ENT, pulmonary, or allergic disorder) Specific treatment | |||||||||||||||||||||||||||||||||||
| REFLUX MONITORING | |||||||||||||||||||||||||||||||||||||
| Low pre test probability of GERD | High pre test probability of GERD | ||||||||||||||||||||||||||||||||||||
| Test off medication with pH or impedance-pH | Test on medication with impedance-pH | ||||||||||||||||||||||||||||||||||||
- High Risk: Men >50 years with chronic gastroesophageal reflux disease symptoms (>5 years), AND:
- Nocturnal reflux symptoms
- Hiatal hernia
- Elevated body mass index
- Tobacco use
- Intra-abdominal distribution of fat
- Angina / ischemia
- Ascites
- Asthma
- Barrett's esophagus
- Cardiotomy
- Caustic agent ingestion with resultant mucosal injury
- Chagas disease
- Cholelithiasis
- Clothes (elevated internal stomach pressure)
- Constipation
- Coronary artery disease
- Coughing
- CREST syndrome (Calcinosis Raynaud's phenomenon Esophagus Sclerodactyly Telangiectasias)
- Direct irritation of esophagus:
- Aspirin
- Cigarette smoke
- Citrus fruits, juice
- Ibuprofen
- Spicy foods
- Tomatoes
- Tomato sauce
- Diabetes
- Drugs:
- Esophageal atresia or fistula
- Esophageal carcinoma
- Esophageal diverticulum
- Esophageal varices
- Foods:
- Alcohol
- Chocolate
- Coffee
- Fatty foods
- Peppermint
- Soft drinks with caffeine
- Tea
- Fundectomy (postoperative)
- Gastrectomy (postoperative)
- Gastritis
- Gastroesophageal reflux disease (GERD)
- Hiatal hernia
- Infectious esophagitis
- Lifting
- Mallory-Weiss tear
- Motility disorders
- Muscle strain
- Myasthenia gravis
- Myocardial infarction
- Obesity
- Peptic ulcer disease
- Pericardial disease
- Pregnancy
- Primary reflux esophagitis
- Pulmonary embolism
- Raynaud's phenomenon
- Scleroderma
- Strictures, webs or rings
- Vagotomy (postoperative)
References
- ↑ "Heartburn vs. heart attack - Harvard Health".
- ↑ Bösner S, Haasenritter J, Becker A, Hani MA, Keller H, Sönnichsen AC; et al. (2009). "Heartburn or angina? Differentiating gastrointestinal disease in primary care patients presenting with chest pain: a cross sectional diagnostic study". Int Arch Med. 2: 40. doi:10.1186/1755-7682-2-40. PMC 2799444. PMID 20003376.