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Medication Causes of Dyspepsia

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881. Esophagitis (Diagnosis)

esophagitis – Radiation therapy; palliative stenting See and for more detail. Next: Background The most common cause of esophagitis is (GERD). Other important, but less common, types of esophagitis include infectious esophagitis (in patients who are immunocompromised), radiation esophagitis, and esophagitis from direct erosive effects of ingested medication or corrosive agents (eg, strong alkalis in liquid and granular forms [ ] ) (see the image below). (See .) Go to for complete information on this topic (...) factors. Reflux esophagitis Factors or conditions that may increase the risk of reflux esophagitis include the following: Pregnancy Obesity Scleroderma Smoking Alcohol, coffee, chocolate, fatty or spicy foods Certain medications (eg, beta blockers, nonsteroidal anti-inflammatory drugs [NSAIDs], theophylline, nitrates, alendronate, calcium-channel blockers) Mental retardation requiring institutionalization Spinal cord injury Immunocompromised state Radiation therapy for chest tumors Helicobacter pylori

2014 eMedicine.com

882. Gastrointestinal Disease and Pregnancy (Diagnosis)

: Disclosure: Nothing to disclose. Acknowledgements Alex J Mechaber, MD, FACP Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine Alex J Mechaber, MD, FACP is a member of the following medical societies: , , and Disclosure: Nothing to disclose. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure (...) smoking, alcoholism, stress, socioeconomic status, and a previous history of PUD or . Nonsteroidal medications are not a common risk factor for PUD in pregnancy unless in combination with colonization with H pylori . [ ] The clinical features of this condition in pregnant women are similar to those in the nonpregnant state. Symptoms include dyspepsia, epigastric pain, nausea, vomiting, and heartburn. [ ] Gastrointestinal bleeding and perforation are rare complications of PUD in pregnancy. PUD does

2014 eMedicine.com

883. Epilepsy and the Autonomic Nervous System (Diagnosis)

foci. [ , , , ] Dyspepsia, pain, hunger, borborygmi, nausea, vomiting, belching, urge to defecate, and fecal incontinence also have been reported. Abdominal pain is common, especially in children. Vomiting also can occur in seizures with opercular, inferior temporal, or occipital foci. [ ] Afferent autonomic fibers play a key role in the epigastric sensations, whereas efferent pathways cause belching, vomiting, and defecation. [ ] Panayiotopoulos syndrome has been classified as a common benign (...) the following: Symptomatic epilepsy Generalized tonic-clonic (GTC) seizure Onset at a younger age Duration of longer than 10 years Higher number of attacks The following are proposed treatment-related risk factors [ , , , , , , ] : Subtherapeutic antiepileptic drug (AED) levels Higher number of AEDS Recent changes in AED regimen History of surgical treatment for seizures Although autopsy, by definition, fails to reveal the underlying cause of death, several autopsy reports confirm a variety of findings

2014 eMedicine.com

884. Eating Disorder: Pica (Follow-up)

is important for managing the detrimental effects pica may have on teeth from a young age onward. [ ] Pharmacologic Therapy No medical treatment is specific for pica. Few studies of pharmacologic therapy for pica have been performed; however, the hypothesis that diminished dopaminergic neurotransmission is associated with pica suggests that drugs that enhance dopaminergic functioning may provide treatment alternatives in individuals with pica that is refractory to behavioral intervention. [ ] In addition (...) , Medicine, Texas Children’s Hospital Angelo P Giardino, MD, PhD, MPH, is a member of the following medical societies: , , , , Helfer Society, and Disclosure: Bayer Honoraria Review panel membership; Pfizer Grant/research funds Independent contractor; MedImmune Honoraria Review panel membership; Teva Pharmaceutical travel & honoraria Managed Care Advisory Panel; CIGNA Honoraria Physician Advisory Council Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College

2014 eMedicine Pediatrics

885. Diphyllobothrium Latum Infection (Follow-up)

of Pediatrics, Tulane University School of Medicine Russell W Steele, MD is a member of the following medical societies: , , , , , , , , and Disclosure: Nothing to disclose. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Salary Employment Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Head of Infectious Disease (...) pointing to operculum. Signs and symptoms Most persons with diphyllobothriasis are asymptomatic. In symptomatic persons, the following are the most common symptoms: Abdominal pain Indigestion or dyspepsia Passage of proglottids Other, less common, symptoms include the following: Fatigue Diarrhea Dizziness Weakness (rare) Numbness of extremities Sensation of hunger Pruritus ani Most patients with diphyllobothriasis have no signs of illness . Rare physical findings that may be noted include the following

2014 eMedicine Pediatrics

886. Peptic Ulcer: Surgical Perspective (Treatment)

. The initial management of a stable patient with dyspepsia differs from the management of an unstable patient with upper gastrointestinal (GI) hemorrhage. In the latter scenario, failure of medical management not uncommonly leads to surgical intervention. Treatment options include empiric antisecretory therapy, empiric triple therapy for H pylori infection, endoscopy followed by appropriate therapy based on findings, and H pylori serology followed by triple therapy for patients who are infected. Breath (...) with gastroduodenal reconstruction (Billroth I) or gastrojejunal reconstruction (Billroth II), or a highly selective vagotomy. Next: Bleeding Peptic Ulcers The principles of management of bleeding peptic ulcers outlined below are equally applicable to both gastric and duodenal ulcers. Endoscopic therapy Upper gastrointestinal (GI) bleeding secondary to a bleeding peptic ulcer is a common medical condition. Endoscopic evaluation of the bleeding ulcer can decrease the duration of the hospital stay by identifying

2014 eMedicine Pediatrics

887. Peptic Ulcer Disease (Treatment)

. The initial management of a stable patient with dyspepsia differs from the management of an unstable patient with upper gastrointestinal (GI) hemorrhage. In the latter scenario, failure of medical management not uncommonly leads to surgical intervention. Treatment options include empiric antisecretory therapy, empiric triple therapy for H pylori infection, endoscopy followed by appropriate therapy based on findings, and H pylori serology followed by triple therapy for patients who are infected. Breath (...) with gastroduodenal reconstruction (Billroth I) or gastrojejunal reconstruction (Billroth II), or a highly selective vagotomy. Next: Bleeding Peptic Ulcers The principles of management of bleeding peptic ulcers outlined below are equally applicable to both gastric and duodenal ulcers. Endoscopic therapy Upper gastrointestinal (GI) bleeding secondary to a bleeding peptic ulcer is a common medical condition. Endoscopic evaluation of the bleeding ulcer can decrease the duration of the hospital stay by identifying

2014 eMedicine Pediatrics

888. Irritable Bowel Syndrome (Overview)

a specific irritable bowel syndrome gene. [ , , ] Psychosocial factors in irritable bowel syndrome Numerous studies have found an increased prevalence of abnormal psychiatric disorders, including anxiety, , personality disorders, and hysteria, in adult patients with irritable bowel syndrome, especially patients referred to medical facilities. These psychological disturbances are not believed to cause or induce the symptoms of irritable bowel syndrome but are thought to influence the patient's perception (...) of the symptoms and affect the clinical outcome. Stressful events are known to affect GI functions and may lead to exacerbation of symptoms in patients with irritable bowel syndrome. In addition, antidepressant or antipsychotic therapy is helpful in some patients with irritable bowel syndrome. A meta-analysis has confirmed the relative efficacy of antidepressant medications in irritable bowel syndrome, particularly in predominantly diarrheic patients experiencing severe pain. [ ] Studies have reported

2014 eMedicine Pediatrics

889. High-Altitude Cardiopulmonary Diseases (Follow-up)

explore using battery-powered, portable continuous positive airway pressure for trekkers as both a means of prevention and treatment for AMS. [ , ] Pharmacologic therapies to prevent and treat high-altitude illness Tables 1 and 2 summarize the pharmacologic therapies used to prevent and treat high-altitude illness. The Wilderness Medical Society has also released consensus guidelines for prevention and treatment of acute altitude illness, which include pharmacologic dosing information. [ ] Successful (...) tachycardia, hypotension (uncommon) Sildenafil Adults: 40 mg PO q6-8h on day 1, then 40 mg PO tid on days 2-6 Not established Dyspepsia, facial flushing, muscle aches Tadalafil Adults: 10 mg PO q12h Not established Dyspepsia, facial flushing, muscle aches Salmeterol [ ] Adults: 125 mcg (1 inhalation) q12h for 1 day before and during ascent Not established Worsening asthma if not used with an inhaled corticosteroid Previous Next: Congenital Heart Disease The murmur from a is caused by flow disturbance

2014 eMedicine Pediatrics

890. Hereditary Periodic Fever Syndromes (Follow-up)

. [ ] Adverse effects of medications A common adverse effect of colchicine is diarrhea, which usually improves with a gradual dose increase. Colchicine should be used with caution in elderly patients and patients with mild-to-moderate cardiac, GI, renal, or liver disease. Dosage reduction is recommended in patients who develop weakness or GI symptoms (anorexia, diarrhea, nausea, vomiting) related to drug therapy. Bone marrow alterations (hemolytic or aplastic anemia, pancytopenia, neutropenia (...) mutations in a pro-inflammatory molecule, as opposed to the previous model, in which loss-of-function mutations in an anti-inflammatory molecule were considered the cause of FMF. Regardless of the underlying mutation that causes FMF, the ultimate mutation appears to increase activation of IL-1 beta and accentuates innate immune activation. This supports the use of IL-1 inhibitors as a therapy for resistant cases (see below). FMF is most common among Sephardic and Ashkenazi Jewish and Arab, Armenian

2014 eMedicine Pediatrics

891. Diphyllobothrium Latum Infection (Treatment)

of Pediatrics, Tulane University School of Medicine Russell W Steele, MD is a member of the following medical societies: , , , , , , , , and Disclosure: Nothing to disclose. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Salary Employment Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Head of Infectious Disease (...) pointing to operculum. Signs and symptoms Most persons with diphyllobothriasis are asymptomatic. In symptomatic persons, the following are the most common symptoms: Abdominal pain Indigestion or dyspepsia Passage of proglottids Other, less common, symptoms include the following: Fatigue Diarrhea Dizziness Weakness (rare) Numbness of extremities Sensation of hunger Pruritus ani Most patients with diphyllobothriasis have no signs of illness . Rare physical findings that may be noted include the following

2014 eMedicine Pediatrics

892. Eating Disorder: Pica (Treatment)

is important for managing the detrimental effects pica may have on teeth from a young age onward. [ ] Pharmacologic Therapy No medical treatment is specific for pica. Few studies of pharmacologic therapy for pica have been performed; however, the hypothesis that diminished dopaminergic neurotransmission is associated with pica suggests that drugs that enhance dopaminergic functioning may provide treatment alternatives in individuals with pica that is refractory to behavioral intervention. [ ] In addition (...) , Medicine, Texas Children’s Hospital Angelo P Giardino, MD, PhD, MPH, is a member of the following medical societies: , , , , Helfer Society, and Disclosure: Bayer Honoraria Review panel membership; Pfizer Grant/research funds Independent contractor; MedImmune Honoraria Review panel membership; Teva Pharmaceutical travel & honoraria Managed Care Advisory Panel; CIGNA Honoraria Physician Advisory Council Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College

2014 eMedicine Pediatrics

893. Peptic Ulcer: Surgical Perspective (Overview)

to disclose. Mutaz I Sultan, MBChB Makassed Hospital, Israel Mutaz I Sultan, MBChB is a member of the following medical societies: and Disclosure: Nothing to disclose. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Salary Employment Alan BR Thomson, MD Professor of Medicine, Division of Gastroenterology, University of Alberta, Canada Alan BR Thomson, MD is a member (...) with PUD are treated successfully with cure of H pylori infection and/or avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs), along with the appropriate use of antisecretory therapy. In the United States, the recommended primary therapy for H pylori infection is proton pump inhibitor (PPI)–based triple therapy. [ ] These regimens result in a cure of infection and ulcer healing in approximately 85-90% of cases. [ ] Ulcers can recur in the absence of successful H pylori eradication. (See

2014 eMedicine Pediatrics

894. Peptic Ulcer Disease (Overview)

to disclose. Mutaz I Sultan, MBChB Makassed Hospital, Israel Mutaz I Sultan, MBChB is a member of the following medical societies: and Disclosure: Nothing to disclose. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Salary Employment Alan BR Thomson, MD Professor of Medicine, Division of Gastroenterology, University of Alberta, Canada Alan BR Thomson, MD is a member (...) with PUD are treated successfully with cure of H pylori infection and/or avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs), along with the appropriate use of antisecretory therapy. In the United States, the recommended primary therapy for H pylori infection is proton pump inhibitor (PPI)–based triple therapy. [ ] These regimens result in a cure of infection and ulcer healing in approximately 85-90% of cases. [ ] Ulcers can recur in the absence of successful H pylori eradication. (See

2014 eMedicine Pediatrics

895. Child Abuse and Neglect: Sexual Abuse (Overview)

(eg, seminal products in a prepubertal female child’s vagina, the presence of a nonvertically transmitted gonorrhea or syphilis infection) Another classification system, developed by Adams et al on the basis of the Muram approach combined with information from other components of the sexual abuse assessment, includes the following 8 categories of findings [ , , ] : Findings documented in newborns or commonly seen in nonabused children (ie, normal variants) Findings commonly caused by other medical (...) the numbers but not impacting the actual amount of children under abuse. No consensus has been reached about what may be causing the steady decline; Finkelhor and Jones draw attention to the idea that factors such as increasing economic prosperity, increasing numbers of agents of social intervention, and increasing availability of highly effective psychiatric medications may very well be leading to a decline in incidence with a resultant decline in substantiations. Mortality/Morbidity Numerous

2014 eMedicine Pediatrics

896. Celiac Disease (Overview)

Associate Program Director, Department of Emergency Medicine, Henry Ford Hospital Phyllis A Vallee, MD is a member of the following medical societies: , , Disclosure: Nothing to disclose. Specialty Editor Board Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Nothing to disclose. Carmen Cuffari, MD Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns (...) and Medical Director, Celiac Disease Center, Chief, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Chicago Medical Center; Professor, Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine Stefano Guandalini, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Coauthor(s) Phyllis A Vallee, MD

2014 eMedicine Pediatrics

897. Eating Disorder: Pica (Overview)

is important for managing the detrimental effects pica may have on teeth from a young age onward. [ ] Pharmacologic Therapy No medical treatment is specific for pica. Few studies of pharmacologic therapy for pica have been performed; however, the hypothesis that diminished dopaminergic neurotransmission is associated with pica suggests that drugs that enhance dopaminergic functioning may provide treatment alternatives in individuals with pica that is refractory to behavioral intervention. [ ] In addition (...) , Medicine, Texas Children’s Hospital Angelo P Giardino, MD, PhD, MPH, is a member of the following medical societies: , , , , Helfer Society, and Disclosure: Bayer Honoraria Review panel membership; Pfizer Grant/research funds Independent contractor; MedImmune Honoraria Review panel membership; Teva Pharmaceutical travel & honoraria Managed Care Advisory Panel; CIGNA Honoraria Physician Advisory Council Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College

2014 eMedicine Pediatrics

898. Cyclic Vomiting Syndrome (Overview)

% completely disabled Contributor Information and Disclosures Author Thangam Venkatesan, MD Associate Professor of Medicine, Fellowship Director, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical College of Wisconsin Thangam Venkatesan, MD is a member of the following medical societies: , Disclosure: Nothing to disclose. Coauthor(s) B UK Li, MD Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin; Attending (...) Gastroenterologist, Director, Cyclic Vomiting Program, Children’s Hospital of Wisconsin B UK Li, MD is a member of the following medical societies: , , Disclosure: Nothing to disclose. Chief Editor Carmen Cuffari, MD Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine Carmen Cuffari, MD is a member of the following medical societies: , , , Disclosure: Received honoraria from Prometheus Laboratories for speaking and teaching; Received

2014 eMedicine Pediatrics

899. Congenital Anomalies of the Esophagus (Overview)

, such as oculodigitoesophageoduodenal (ODED) syndrome (ie, Feingold syndrome), trisomy 18, and . Other etiologic factors (eg, vitamin deficiencies; drug exposures; viral, chemical, and physical external events) have been reported to cause tracheoesophageal malformations in experimental models and in humans. Other congenital anomalies One proposition is that esophageal webs result from a failure of esophageal vacuoles to coalesce at 25-31 days' gestation, which normally leads to complete luminal patency. True esophageal (...) weight does not affect survival rate unless it is severely low, and pneumonia may be treated successfully. Currently, cardiac and chromosomal abnormalities are the most significant causes of death. Infants with a birth weight less than 1500 g, major congenital cardiac abnormalities, severe associated anomalies, preoperative ventilator dependence, and/or long gap are at increased risk. Dysphagia, frequent night coughs, dyspepsia, and recurrent respiratory infections are frequent results of the less

2014 eMedicine Pediatrics

900. Gout (Treatment)

with a single drug. Low-dose aspirin is also uricosuric. The angiotensin-receptor blocker (ARB) losartan should be considered, because it is uricosuric at 50 mg/day. However, medications that elevate uric acid can still be used, if required, by making appropriate adjustments of allopurinol or probenecid doses. Urinary excretion amounting to less than 800 mg per 24-hour period on an unrestricted diet is considered underexcretion. Underexcreting patients are candidates for uricosuric therapy with probenecid (...) beginning therapy with a uric acid–lowering agent, the agent should not be discontinued, because discontinuance will only cause another flux in the uric acid level, which may prolong and intensify the attack. Allopurinol Allopurinol blocks xanthine oxidase and thus reduces the generation of uric acid. Approximately 3-10% of patients taking allopurinol develop symptoms of intolerance, such as dyspepsia, headache, diarrhea, or pruritic maculopapular rash. Less frequently (1% of cases), patients taking

2014 eMedicine Surgery

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