Oesophageal acidification may cause such sudden and brisk stimulation of salivation that the patient’s mouth fills with saliva.
Angina-like chest pain
Respiratory symptoms asthma, chronic cough, laryngitis and sinusitis, wheeze, hoarseness or sore throa
Dysphagia: Dysphagia that is associated with symptoms of bolus impaction is highly suggestive of a stricture.
Odynophagia (painful swallowing)
Bleeding from oesophagitis
History: symptom based
substantial overlap between the symptoms of reflux disease and those of ulcer disease, non-ulcer dyspepsia and irritable bowel syndrome
Dyspepsia: approximately two-thirds of patients will also complain of (upper abdominal pain or discomfort)
about 40% of patients with IBS also complain of reflux symptoms.
1. Double-dose proton pump inhibitor for two weeks
2. Sensitivity and specificity for reflux disease that is comparable to that of oesophageal pH monitoring and substantially superior to endoscopy
1. sensitive test for reflux oesophagitis
2. gives the most accurate diagnosis of other mucosal lesions such as infective oesophagitis, peptic ulcer disease, malignancy or other
Barium swallow and meal
1. This is an inappropriate primary diagnostic and non-specific for reflux disease.
2. To assess and plan management in patients with persistent dysphagia large hiatal herniae.
24-hour ambulatory oesophageal pH monitoring
1. Relieve symptoms
2. Restore quality of life
3. Heal oesophagitis if present
4. Reduce the risk of complications