OTC Heartburn Counseling: Alarm Symptoms and What They Might Mean

Symptoms Requiring MD Referral During OTC Counseling for Heartburn 3

·         Heartburn >3 months      ·         Heartburn persisting after 2 weeks of OTC treatment      ·         Heartburn persisting  while on appropriate dose of Rx or OTC PPI/H2RA      ·         Nocturnal  heartburn      ·         Dysphagia/difficulty swallowing      ·         Vomiting blood/black tarry stools      ·         Chronic hoarseness/wheezing/cough      ·         Unintentional weight loss      ·         Persistent nausea/vomiting/diarrhea      ·         Chest pain accompanied by MI symptoms      ·         Children <2 (antacid), children <12 (H2RA), <18 (PPI)      ·         < 45 years old with new-onset heartburn

GERD Presentation 1 (occurring > 2x/week, or interfering with ADL’s)	Peptic Ulcer Disease Presentation4
·         Heartburn, burning sensation may spread to throat  accompanied by sour taste      ·         Chest pain      ·         Dysphagia      ·         Dry cough      ·         Hoarseness      ·         Sore throat      ·         Regurgitation      ·         Lump-in-throat sensation	·         Heartburn      ·         Localized pain/discomfort in center of abdomen      ·         Symptoms improved when patient has empty stomach or eats to satiety      ·         Blood in vomit, stools      ·         Fatigue, dyspnea (signs of anemia)      ·         Dyspepsia- belching, bloating, distention

GERD Risk Factors1	PUD Risk Factors5
·         Obesity      ·         Hiatal hernia           ·         Pregnancy      ·         Smoking      ·         Dry mouth      ·         Asthma      ·         Diabetes      ·         Delayed stomach emptying      ·         Connective tissue disorders (scleroderma)	·         Smoking      ·         Heavy alcohol use      ·         Elderly      ·         Family history      ·         ICU patients      ·         Illicit drug use o   Crack cocaine, methamphetamine      ·         Regular NSAID use

References:

1. "GERD." Causes. Web.29 July 2015. <http://www.mayoclinic.org/diseases-conditions/gerd/basics/symptoms/con-20025201>.

2. Katz, Philip O, Lauren B Gerson, and Marcelo F Vela. "Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease." Am J Gastroenterol The American Journal of Gastroenterology (2013): 308-28.

3. Facts & Comparisons. Accessed 3 August 2015. <www.online.factsandcomparisons.com.proxy.lib.uiowa.edu>

4. "Peptic Ulcer Disease Clinical Presentation." Peptic Ulcer Disease Clinical Presentation: History, Physical Examination, Staging. Web. 4 Aug. 2015. <http://emedicine.medscape.com/article/181753-clinical>.

5. "Peptic Ulcer Disease." Causes, Diagnosis & Treatments. Web. 4 Aug. 2015. <https://www.clinicalkey.com/topics/gastroenterology/peptic-ulcer-disease.html>.

6. Vakil, NB. Peptic ulcer disease: Management. In: UptoDate. Feldman M (Ed). UpToDate. Accessed 8/4/15. < http://www-uptodate-com.proxy.lib.uiowa.edu/contents/peptic-ulcer-disease-management?source=machineLearning&search=peptic+ulcer+disease&selectedTitle=1~150&sectionRank=1&anchor=H19#H17>

7. Crowe, SE. Treatment regimens for Heliobacter pylori. In: UpToDate. Feldman, M (Ed). UpToDate. Accessed 8/4/15. < http://www-uptodate-com.proxy.lib.uiowa.edu/contents/treatment-regimens-for-helicobacter-pylori?source=see_link>