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  #1  
Old 05-31-2012
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Question epigastric pain+normal endoscopy->next step ?

A 58-year-old woman is evaluated for a 3-month history of burning midepigastric pain after
eating and early satiety.
The pain feels the same as a gastric ulcer she had 10 years ago.
She reports no associated sour taste, belching, bloating, or worsening symptoms with recumbency or at night. She has no nausea, vomiting, painful swallowing, changes in bowel
habits, or weight loss. She is otherwise in good health and has no symptoms of anxiety or
depression.
On physical examination, vital signs are normal. Mild midepigastric tenderness is present, but
her physical examination is otherwise normal.
A thyroid-stimulating hormone level, complete blood count, and metabolic panel are normal.
An upper endoscopy is performed and it is normal. Testing for H. pylori is negative.
Which of the following is the most appropriate management for this patient?
(A) Ambulatory esophageal pH monitoring
(B) Psychiatric evaluation
(C) Surgical evaluation
(D) Trial of a proton pump inhibitor (PPI)
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  #2  
Old 05-31-2012
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may be D.....but not sure.......
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Old 05-31-2012
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i think d also
she may have gerd
which will be normal on upper gi endoscope
so atrial of ppi may be considered to avoid exhaustive upper gi investigation .
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  #4  
Old 05-31-2012
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-pt has Hx of gastric ulcer ,pain after eating &early satesfy=the option of ca is high ,iwill go for surgical evalution.(c).
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Old 05-31-2012
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this is non-ulcer dyspepsia (pain & nl endo & negative H.pylori) --> PPI
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Old 05-31-2012
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she has a 10 year history of gastric ulcer...
and now additional 3 months history of symptoms..

high likely hood of cancer..

PPIs will be given.. yes.. but before that i think we shud rule out cancer...
so SURGICAL EVALUATION?

endoscopy?
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Old 05-31-2012
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Quote:
Originally Posted by tyagee View Post
A 58-year-old woman is evaluated for a 3-month history of burning midepigastric pain after
eating and early satiety. The pain feels the same as a gastric ulcer she had 10 years ago.
She reports no associated sour taste, belching, bloating, or worsening symptoms with recumbency or at night. She has no nausea, vomiting, painful swallowing, changes in bowel
habits, or weight loss. She is otherwise in good health and has no symptoms of anxiety or
depression.
On physical examination, vital signs are normal. Mild midepigastric tenderness is present, but
her physical examination is otherwise normal.
A thyroid-stimulating hormone level, complete blood count, and metabolic panel are normal.
An upper endoscopy is performed and it is normal. Testing for H. pylori is negative.
Which of the following is the most appropriate management for this patient?
(A) Ambulatory esophageal pH monitoring
(B) Psychiatric evaluation
(C) Surgical evaluation
(D) Trial of a proton pump inhibitor (PPI)
(D) Trial of a proton pump inhibitor (PPI)

Quote:
The current gold standard for diagnosis of GERD is esophageal pH monitoring. It is the most objective test to diagnose the reflux disease and it also allows to monitor GERD patients in regards of their response to medical or surgical treatment. One practice for diagnosis of GERD is a short-term treatment with proton pump inhibitors, with improvement in symptoms suggesting a positive diagnosis. According to a systematic review, short-term treatment with proton pump inhibitors may help predict abnormal 24-hr pH monitoring results among patients with symptoms suggestive of GERD.[8] In this study, the positive likelihood ratio of a symptomatic response detecting GERD ranged from 1.63 to 1.87, with sensitivity of 0.78 though specificity was only 0.54.
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  #8  
Old 05-31-2012
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ans is PPI
coz of non ulcer dyspepsia...

and symptoms are not consistent with gerd...working diagnosis will be NUD !
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