Helicobacter pylori infection does not cause GORD and actually appears to be slightly protective against it, Barrett’s oesophagus and oesophageal adenocarcinoma. 13, 14 Usually a specialist consultation is needed. These studies are only required in a minority of patients who are either refractory to treatment or are being assessed for surgery. Findings of gastro-oesophageal reflux induced by position or abdominal pressure are neither sensitive nor specific for GORD. There is no role for the barium swallow in the routine diagnosis of GORD. 12 However, it may have a role in high-risk groups such as the overweight and Caucasian males over 50 years old with no previous endoscopic investigation. 11 There is no evidence that routine screening for Barrett’s oesophagus improves mortality or is cost-effective. Biopsy may be needed to exclude eosinophilic oesophagitis. in overweight men over 50 years, however evidence that screening improves outcomes is lacking)Įosinophilic oesophagitis should be considered in patients, particularly men, in their 20s and 30s with a history of food allergy or atopy who present with dysphagia or refractory symptoms suggestive of GORD. Screening for Barrett’s oesophagus in high-risk patients (may be considered, e.g. Treatment of complications such as dilatation of oesophageal stricturesĮvaluation of patients before and after anti-reflux surgical procedures
MEDICATION FOR GORD TRIAL
Persistent symptoms despite an adequate trial of proton pump inhibitor therapy Indications for gastroscopy in gastro-oesophageal reflux disease 9 4 The correlation between symptoms and the severity of oesophagitis is weak, but if typical features are present without ‘red flags’ ( Box 1) 9 then there is no need for gastroscopy in the initial assessment and empirical treatment can commence. While several validated symptom-based questionnaires exist, their use is largely limited to research studies. 4 Other non-specific symptoms include vomiting, anorexia, dysphagia, cough and other respiratory or oropharyngeal symptoms. Regurgitation is described as the effortless appearance of gastric contents in the throat or mouth without associated nausea or retching. 4 Practitioners need to be aware of this and clarify the nature of the symptoms being discussed when the term is used. Heartburn is described as a burning, retrosternal, rising sensation associated with meals, although this definition is often poorly understood by the general population. The presence of either symptom has an overall sensitivity of 49% and specificity of 74%. 4 For this reason, symptoms of sciatica often co-exist with low back pain, but disturbances along the course of the sciatic nerve can also arise from locations other than the lower back (ie, due to piriformis syndrome, diabetic radiculopathy, and hip fracture or dislocation).A presumptive diagnosis of GORD can be made based on the typical symptoms of heartburn and regurgitation. Other causes of impingement include spondylolisthesis and spinal tumours or cysts. The commonest cause of sciatica is impingement of lumbosacral nerve roots, as they emerge from the spinal canal, by a herniated intervertebral disc (fig 1). Sciatica is a symptom rather than a specific diagnosis 4 and is used broadly to refer to pain that radiates along the path of the sciatic nerve. 2 Nevertheless, in another study of 172 patients, 30% continued to report persistent and disabling symptoms after one year. 1 The prognosis of acute sciatica is generally favourable: data from a prospective study of 183 patients with a median disease duration of 16 days show that in approximately one third of patients, symptoms improve greatly (ie, measured on a 4 point scale, 1=worsened, 2=remained unchanged, 3=improved, and 4=improved greatly) within two weeks, and about three quarters of patients reported any improvement within 12 weeks. Its prevalence in the general population varies between 3% and 14%, depending on the definition used. Sciatica is commonly seen in primary care. Medications used for the treatment of sciatica can have considerable side effects
In approximately one third of patients, symptoms improve within two weeks in three quarters of patients, symptoms improve within 12 weeks, but about a third of patients have persistent and disabling symptoms after one year 3 The most effective pain medication to treat patients with sciatica or radicular leg pain is unclear
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