Gastrointestinal Conditions

I’ve had gastroesophageal reflux disease (GERD) for years and have always been surprised about that because I don’t really have any risk factors. I’m a thin exercise fanatic and don’t eat any foods that would predispose to GERD. Thus, I read Section One of this FP Essentials, about GERD, with great interest. And, despite being physician and a long-time GERD patient, I learned a few new things.

For example, I have always thought it was best to sleep on my right side, figuring the stomach drains to the right through the pylorus. So, sleeping on the right would help the stomach drain out through the pylorus, leaving an empty stomach that cannot reflux. But guess what? Sleeping on the left is actually better. I typically also have taken proton pump inhibitors (PPIs) approximately an hour before dinner, figuring that would provide maximal protection against reflux that occurs when supine at night, rather than taking them in the morning and having PPI action wear off by nighttime. But by taking PPIs in the morning when the stomach is completely empty, PPI action lasts for approximately 48 hours.

There also is lots of other useful information in this edition. We have all had gastroenteritis at one time or another during our lives, and Section Three discusses all the new testing options and guidelines for using them. There is also lots of useful information in Sections Two and Four about new approaches to dealing with peptic ulcer and pancreatitis, respectively.

I hope you will find this edition of FP Essentials as useful and informative as I did.

Barry D. Weiss, MD, FAAFP, Medical Editor
Professor, Department Family and Community Medicine
University of Arizona College of Medicine, Tucson

Justin M. Bailey, MD, FAAFP, is the director of endoscopy and the Procedural Institute for Full Circle Health in Boise, Idaho, where he teaches full-spectrum/rural family medicine at the Family Medicine Residency Program. He is a clinical associate professor of Family Medicine at the University of Washington. He is also president of the American Association of Primary Care Endoscopy (AAPCE), the endoscopy arm of the American Academy of Family Physicians (AAFP).

Disclosure: It is the policy of the AAFP that all individuals in a position to control CME content disclose any relationships with ineligible companies upon nomination/invitation of participation. Disclosure documents are reviewed for potential relevant financial relationships. If relevant financial relationships are identified, mitigation strategies are agreed to prior to confirmation of participation. Only those participants who had no relevant financial relationships or who agreed to an identified mitigation process prior to their participation were involved in this CME activity. All individuals in a position to control content for this activity have indicated they have no relevant financial relationships to disclose.

• Summarize appropriate tests to confirm the diagnosis of gastroesophageal reflux disease when patients have typical symptoms but do not benefit from standard therapy.
• Counsel patients on the proper administration of proton pump inhibitors.
• Discuss appropriate tests and management for Helicobacter pylori infection.
• Confirm eradication of H pylori infection with testing at the appropriate time after treatment.
• Summarize appropriate multiplex microbial testing when needed for patients with acute gastroenteritis.
• Identify patients with gastroenteritis for whom empiric antibiotic therapy is indicated.
• Discuss current guideline-recommended criteria for acute pancreatitis diagnosis.
• Summarize proper fluid administration and oral feeding for patients with acute pancreatitis, based on current guidelines.