Patients with complications always require consultation, and most require admission to an appropriate inpatient unit based on the diagnosis and hemodynamic stability. Most patients with epigastric pain or dyspepsia do not leave the emergency department with a definitive diagnosis, but if critical diagnoses (e.g., AAA or myocardial ischemia) are still in the differential, consultation for admission and appropriate workup is indicated. When uncomplicated peptic ulcer disease, gastritis, or dyspepsia is strongly suspected, the great majority of patients can be discharged with antacids and an H 2RA, with or without a seralogic test for H. pylori, and close follow-up with their primary care provider. If "alarm" features (indicating possible cancer or bleeding) are present, consultation for early endoscopy is indicated.
Discharge instructions should include an explanation of the diagnosis and home treatment, specific follow-up instructions, and warning symptoms that should prompt immediate reevaluation. The explanation of the diagnosis should specify that peptic ulcer disease is a presumptive diagnosis and that more definitive diagnostic testing may be necessary. Home treatment should include a reminder to take medications as directed; a warning against use of alcohol, tobacco products, and aspirin or other NSAIDs; and a recommendation to avoid foods that appear to upset the individual's "stomach." Specific follow-up should include a name and phone number of the appropriate provider whenever possible as well as a time frame for reevaluation, generally 24 to 48 h if not improving or 1 to 2 weeks if improving. Warning symptoms that merit immediate reevaluation include those that may be attributed to ulcer complications or confounding illness: worsening pain, increased vomiting, hematemesis or melena, weakness or syncope, fever, chest pain, radiation of pain to the neck or back, and shortness of breath.
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Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.