1. Treatment non pharmacology
1.1. Avoid trigger food
1.1.1. Chocolate
1.1.2. Alcohol
1.1.3. Caffeine
1.1.4. Rich
1.1.5. Spicy
1.1.6. Fatty food
1.2. Overweight weight loos
2. Acid reflux
3. Avoid smoking
4. Expected after meals and at bed time
5. Some patient take other medications adverse effect NSAID ,iron,bisphosphonates ,corticosteroids
5.1. Dyspepsia
6. Dyspepsia
6.1. Symptoms
6.1.1. Upper abdominal
6.1.2. Discomfort
6.1.3. Pine
6.1.4. Heartburn
6.1.5. Nausea
6.1.6. Vomiting
6.1.7. With or without bloating
6.1.8. Expected after meals and at bed time
6.2. Diagnosis
6.2.1. Endoscopy
6.3. Treatment pharmacology
6.3.1. Simple anti acid management
6.3.2. Retdnine
6.3.3. H2 antagonist histamine receptors blockade 75mg alginates
6.3.4. Proton pump inhibitors
7. GORD in adult
7.1. Symptoms
7.1.1. Burning
7.1.2. Felt behind
7.1.3. Heartburn
7.2. Treatment
7.2.1. Proton pump inhibitor
7.2.1.1. Omeprazole 10mg 4 weeks
7.2.1.2. Pantoprazole
7.2.1.3. Esomeprazole 14weeks
7.2.2. NoN Pharmacology
7.2.2.1. Reduce the intake alcohol
7.2.2.2. Stop Caffeine
7.2.2.3. Stop Fatty food
7.2.2.4. Stope smoking
7.2.3. Anti acid management relief in GORD
7.3. Risk factor
7.3.1. Foods:fatty food ,citrus fruits,onions,coffee
7.3.2. Drug which relax :CCB ,theophylline and nitrate
7.3.3. Smoking
7.3.4. Alcohol
7.3.5. Obesity
7.3.6. Genetic factor
7.4. 999
7.4.1. Emergency symptoms possible cardiac pin ,breathing difficulties,vomiting blood/coffee ground vomit
7.5. Self care
7.5.1. No OTC treatment yet tried
7.6. Urgent GP Referral dysphagia difficulty in swallowing
7.7. Routine Referral to GP Surgery
7.7.1. OTC failure
7.7.2. Medications ADR
7.7.3. Unexplained weight loss
7.7.4. Night time waking with acid in throat
7.8. Accident and emergency
7.8.1. Malden abdominal pine radiating to the back Malena