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GORD/Dyspepsia - Coggle Diagram
GORD/Dyspepsia
Referral to GI
Non tolerance to treatment
Associated risk factors Barrets Oesophagus
Symptoms persist
Upper abdo pain with low Hb
Urgent - see red flags
Raised Platelet count with nausea, vomiting, wt loss, reflux, dyspepsia, upper abdo pain
Nausea or vomiting with weight loss, reflux, dyspepsia, upper abdo pain
Recurrence
Adherence to Management
Lifestyle advice
Differential diagnosis
Cardiac
Hepatobiliary
Full or double dose PPI further 4 weeks
Add H2RA at bedtime for confirmed oesophagitis
H2RA for confirmed endoscopy-negative reflux disease
Management
Review of current medication
full dose PPI 4 weeks- proven GORD
Lifestyle changes/Raise head of bed when sleeping
Full PPI dose 8 weeks- severe oesophagitis
Risks- symptom recurrence
severe oesophagitis 80%
developing Barretts oesophagus - 10-15%
oesophageal adenocarcinoma 1-10%
Untreated 50%
Review
Annually
Maintenance lowest dose
RED FLAGS
Abdominal Mass
Weight loss
Reflux
Abdominal pain
Over 55 years of age
URGENT REFERRAL
Definition - "complex of upper gastrointestinal tract symptoms which are typically present for four or more weeks, including upper abdominal pain or discomfort, heartburn, acid reflux, nausea and/or vomiting" (NICE,2017).
Pathophysiology - Persistant reflux of gastric contents into the oesophagus that is assosciated with a weak or incompetent lower oesophageal sphincter
Risk Factors
Lifestyle (obesity, smoking, coffee, stress, alcohol, trigger foods)
Medication - calcium-channel blockers, anticholinergics, theophylline, benzodiazepines, and nitrates.
Pregnancy