Today’s pearls are tomorrow’s fecaliths.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is a valuable resource for pt education materials. Information is distributed through the National Digestive Diseases Information Clearinghouse (NDDIC). Publications are available online, and copies suitable for distribution to pts can be ordered at their Web site: http://catalog.niddk.nih.gov/materials.cfm?CH=NDDIC.

GERD is a frequently mismanaged illness. Physicians often underestimate the impact GERD has on quality of life and dismiss it as a minor problem notworthy of aggressive therapy (p 33).

Hp infection limited to the antrum might worsen reflux by increasing acidity. However, more commonly (especially in the developing world), Hp gastritis infects the antrum and body of the stomach, and the resultant gastritis reduces acid production and reduces the incidence of GERD (p 34).

Most PPIs must be given 30 min to 1 hr prior to breakfast for optimal effect because they require meal-stimulated parietal cell pH drop for effective binding. H2RAs should notbe given prior to PPI doses, as they block PPI binding (see p 37).

Many pts with dysphagia and recurrent episodes of food impaction will notvolunteer this important hx unless asked. Since most dysphagia is readily treatable, this sx must notbe overlooked (p 6).

Pts with reflux-related strictures should be maintained on PPIs (notH2RAs) to reduce the risk of recurrence (p 45).

Though surveillance for Barrett’s esophagus is widely performed in the U.S., its benefits are far from proven, its costs are high, the yield is modest, and the optimum surveillance strategy has notyet been determined (p 41).

Gastritis is best considered a histologic term. There are no consistent sx or endoscopic findings that correlate with the microscopic appearance of gastritis (see p 63).

There is little point to obtaining a UGI series in the evaluation of dyspepsia. The sensitivity of UGI series for ulcers and esophagitis is limited. If the UGI series shows a gastric ulcer, EGD is done to rule out malignancy, and if the UGI is negative, EGD is still needed for dx (p 2).