03-05-2010, 04:30 AM
AAA
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try this ,nice qs - splitpersonality
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03-05-2010, 02:14 PM
GERD not controled by medical rx ,the next option is funduplication . surgery
03-05-2010, 02:57 PM
answer id D
The term œrefractory gastroesophageal reflux is very misleading. High-dose (double-dose) proton pump inhibitors (PPIs) are extremely potent acid suppressants, and other diagnoses should therefore be considered in patients who remain symptomatic after taking high-dose PPIs. This patient's symptoms are not typical for gastroesophageal reflux disease. She does not have regurgitation, and her symptoms of pressure and epigastric discomfort in association with a normal upper endoscopic examination suggest that she has nonulcer dyspepsia. A low-dose antidepressant, such as trazodone, may therefore be effective. Patients who are unresponsive to PPIs generally do not have improved symptoms following antireflux surgery. This patient is already taking a twice-daily PPI, and she is therefore unlikely to benefit from increasing the dose of the PPI or adding ranitidine at bedtime
03-05-2010, 03:52 PM
but in the q's it says refrac gerd. gerd means in inappropriate relaxation of the LES.when the q's says gerd ,it is assumed as the dx. the response is relative to med rx 2/3and I have seen people with surgery not completly satified either but that is how the sequence of rx is.
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