Volume 99, Issue s8

Gastroesophageal reflux disease (GERD) is one of the most common ailments that can decrease quality of life to below that of patients with congestive heart failure. Patients can present with typical, atypical, or serious symptoms, either alone or in combination. History, esophagogastroduodenoscopy, and 24-hour pH monitoring can help with the diagnosis; but all are not needed for each patient. This clinical review will help primary care physicians to make a rapid diagnosis, guide subsequent treatment, and indicate when to order additional testing or referral, or both.

Helicobacter pylori infection continues to be one of the hottest topics in gastroenterology, challenging the primary care physician daily with the clinical application of its new developments and frequency of involvement in differential diagnosis. This article offers'the primary care physician a practical approach to the dyspeptic office patient that emphasizes the differential diagnosis of H pylori. Included is a strategy for rapid patient evaluation through key questions in the history, simple maneuvers in the physical examination, and a logical approach to testing and therapy based on the latest literature. The recommendations for all these office-based steps are designed to be efficient, cost-effective, and clinically relevant.

This article outlines the mechanisms involved in specific cyclooxygenase-l (COX-1) and cyclooxygenase-2 (COX-2) inhibition as they relate to the safety of nonsteroidal anti-inflammatory drug (NSAID) use. New advancements in COX-2 technology appear to improve the safety profile of NSAID therapy. Gastroenterologic issues such as ulcer disease and liver disease as related to .these novel new medications are reviewed.

Inflammatory bowel disease is a chronic, lifelong disorder characterized by alternating periods of flare-ups and clinical remission. The majority of patients experience relapses several rimes a year. Prevention and treatment of these relapses are a major challenge to the practicing physician. Therefore, this article provides strategies that the primary care physician can use in the diagnosis and treatment of inflammatory bowel disease and prevention of relapses.