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2 results

  • Neuropathy – HIV related

  • from Chief complaints and diagnoses
  • Edited by Stephen H. Thomas
  • Book:
    Emergency Department Analgesia
    Published online:
    18 December 2009
    Print publication:
    25 September 2008, pp 285-288

  • Summary

    Opioids such as morphine are often used early in patients subsequently diagnosed with gastroesophageal reflux disease (GERD). Antacids provide GERD relief by buffering the refluxed gastric contents. Antacids are readily available, relatively safe, and fast acting. Antacids constitute first-line GERD therapy in pregnancy. Proton pump inhibitors (PPIs) are a first-line treatment for non-cardiac chest pain, and for GERD in particular. H2-receptor antagonists such as ranitidine (150 mg PO as needed for GERD pain) have been shown in double-blinded trials to achieve better on-demand pain relief than antacids. Prokinetic drugs such as metoclopramide and cisapride are postulated to relieve GERD by increasing resting lower esophageal sphincter tone and increasing gastric emptying. The novel prokinetic agent itopride has promising preliminary results in an open-label GERD trial, but recommendation for its acute care use must await further data.

  • Neuropathy – diabetic

  • from Chief complaints and diagnoses
  • Edited by Stephen H. Thomas
  • Book:
    Emergency Department Analgesia
    Published online:
    18 December 2009
    Print publication:
    25 September 2008, pp 280-284

  • Summary

    This chapter groups the clinically distinct, but similarly treated, entities of gastritis and peptic ulcer disease (GPUD). It focuses on patients with organic disease, with some concluding notes on the challenging management of functional dyspepsia. The most basic treatment for patients with GPUD is administration of antacids. A typical trial finds that administration of colloidal bismuth subcitrate provides significant pain relief in just over half of patients with either gastritis or duodenitis. The reason that agents such as antacids and bismuth salts are reserved for occasional symptomatic relief is that more consistent success is achieved with newer agents such as the proton pump inhibitors (PPIs). The PPIs also relieve symptoms better than does the gastroprotective agent sucralfate when altered gastroduodenal motility is a postulated occasional cause of gastritis, the prokinetic drugs have been employed to treat GPUD.