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DDxPro
Possible Diagnoses
Barrett esophagus
Barrett esophagus
Gerd-related symptoms
Heartburn
Regurgitation
Postprandial burning sensation
Retroesternal burning sensation
First-degree relatives with esophageal adenocarcinoma
Chest pain
Dyspnea
Wheezing
Central obesity
Chest discomfort
Erosive esophagitis
Recurrent aspiration pneumonias
Smoking
Sour taste in throat
Tobacco use
Cough
Dysphagia
Laryngitis
Asthma-like symptoms
Gastroesophageal reflux disease
Gastroesophageal reflux disease
Hiatal hernia
Heartburn
Retrosternal burning pain
Substernal region warmth
Regurgitation
Postprandial
Pain radiate to neck
Dyspepsia
Globus sensation
Chronic cough
Dysphagia
Odynophagia
Chest pain
Laryngitis
Complication asthma
Bloating
Early satiety
Halitosis
Weight loss
Gnawing pain
Achalasia
Achalasia
Dysphagia for solids
Difficulty belching
Dysphagia for liquids
Regurgitation
Heartburn
Substernal chest pain
Weight loss
Esophageal tortuosity
Cough
Fullness relieved by vomiting
Hiccups
Induce vomiting
Pulmonary symptoms
Relieved by vomiting
Retrosternal fullness after meal
Globus sensation
Aspiration
Pseudoachalasia
Bronchitis
Lung abscess
Obstructive sleep apnea
Obstructive sleep apnea
Obstructive apneas
Obstructive hypopneas
Poor concentration
Respiratory effort related arousals
Resuscitative snorts
Sleepiness
Large neck circumference
Large waist circumference
Fatigue
Nocturnal restlessness
Snoring
Nocturnal choking
Nocturnal gasping
Breathing pauses during sleep
Wake-time sleepiness
Retrognathia
Nasal congestion
Acromegaly
Adenoid hypertrophy
Asthma
Peptic ulcer
Peptic ulcer
Centered in epigastrium
Epigastric pain
Awakes the patient from sleep
Relief with anti secretory agents
Recurs when stomach is empty
Burning pain
Upper abdomen discomfort
At night
Relieved by eating
Relief with antiacid
Gnawing pain
Worsens with eating
Dyspepsia
Patient show site of pain with one finger
Vomiting after eating
Radiate to back
Meal related
Recurrent abdominal pain
Weight loss
Anorexia
Acute peptic ulcer
Awakes from sleep
Relief with anti secretory agents
Abdominal pain
Intense pain
More localized pain
Recurs when stomach is empty
Sudden onset
When stomach is empty
Burning pain
Upper abdomen discomfort
At night
Epigastric pain
Hunger-like pain
Sudden severe abdominal pain
Relieved by eating
Relief with antiacid
Awakes the patient from sleep
Hematochezia
Vomiting
Diffused
Gastric ulcer
Awakes from sleep
Relief with anti secretory agents
Recurs when stomach is empty
When stomach is empty
Burning pain
Upper abdomen discomfort
At night
Epigastric pain
Hunger-like pain
Relieved by eating
Relief with antiacid
Awakes the patient from sleep
Discomfort or pain in upper belly
Discomfort or pain near the ribs
Upset stomach
three months
Diarrhea
Burning
Symptom onset at least six months
Abdominal pain
Duodenal ulcer
Awakes from sleep
Relief with anti secretory agents
Recurs several hours after a meal
Recurs when stomach is empty
When stomach is empty
Burning pain
Upper abdomen discomfort
At night
Epigastric pain
Hunger-like pain
Relieved by eating
Relief with antiacid
Awakes the patient from sleep
Vomiting after eating
Radiate to back
Meal related
Epigastric tenderness
Nausea relieved by eating
Severe abdominal pain
Discomfort or pain in upper belly
Esophagitis
Esophagitis
Substernal region pain
Weight loss
Dysphagia to solid foods
Odynophagia
Episodic dysphagia
Regurgitation
Slowly progressive over years
Unchanged over years
Vomiting
Due to delayed hypersensitiv- ity reaction to food allergens
Centrally located chest pain
Dysphagia
Esophageal food impaction
Chest pain
Chest discomfort
Heartburn
Food impaction
Long standing dysphagia
After radiation therapy
Allergic conditions
Non-alcoholic fatty liver disease
Non-alcoholic fatty liver disease
Fatigue
Malaise
Right upper abdominal discomfort
Hepatomegaly
Ascites
Encephalopathy
Palmar erythema
Spider angiomata
Splenomegaly
Jaundice
Associated with metabolic syndrome
Stigmata of chronic liver disease
Associated with chronic pain syndrome
Associated with endothelial dysfunction
Associated with plaques in carotid
Associated with plaques in coronary arteries
Associated with thyroid dysfunction
Mood alterations
Obstructive sleep apnea
Associated with cardiovascular disease
Hiatus hernia
Hiatus hernia
Substernal region pain
Epigastric pain
Nausea
Postprandial fullness
Retching
Substernal region fullness
Auscultation reveal gastric sounds in chest
Dysphagia
Dyspnea
Heartburn
Hematemesis
Painful swallowing
Reflux of sour liquid material
Wheezing
Chills
Confusion
Fevers
Nonbilious vomiting
Oropharyngitis
Esophageal dysphagia
Zollinger-ellison syndrome
Zollinger-ellison syndrome
Develop peptic ulcers
Abdominal pain
Peptic ulcer associated with endocrinopathy
Peptic ulcer refractory to treatment or persistent
Sporadic gastrinomas
Ulcers presenting with frank complications
Diarrhea
Steatorrhea
Associated with gastroesophageal reflux disease
Gastrointestinal bleeding
Associated with duodenal ulcer
Mild esophagitis
Chronic unexplained diarrhea
Ulcers in absence of nsaid ingestion
Perforation
Recurrent severe multiple peptic ulcers
Accelerate transit
Multiple recurrent complicated duodenal ulcers
Refractory diarrhea
Severe diarrhea
Obesity
History (rate of weight gain, dietary history, caloric expenditure, prescribed diet for successful weight loss...)
BMI and waist circumference
Management
BMI < 25
Counsel regarding diet/exercise to ideal BMI (23)
BMI < 30
BMI 30–35
Lipids (fasting) Glucose (fasting) Blood pressure control Make a dietary plan and follow-up, if...
BMI 35–40
BMI > 40
Try all modalities If unsuccessful, consider bariatric surgery
Thyroid stimulating hormone AM/PM cortisol Ultrasound for polycystic ovaries
Heartburn
History, Physical examination
Typical symptoms
PPI
Relief by PPI
Step-down therapy
Infrequent recurrence
Treat again
Frequent recurrence
Maintenance PPI
Failure by PPI
Twice-Daily PPI Therapy
Relief by twice-PPI
Maintenance PPI
Failure by twice-PPI
Document reflux: 24-hr pH on PPI
Normal 24-hr pH
Alternative therapy
Reflux 24-hr pH
Increase PPI dose
Upper endoscopy for patient at high risk for Barrett’s esophagus
Alarm symptoms and signs
Upper Endoscopy