Primary care
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Celiac disease is an immune-mediated enteropathy triggered by gluten that affects genetically predisposed individuals, typically causing intestinal symptoms and malabsorption. Diagnosis requires stepwise evaluation with anti-tissue transglutaminase IgA and histologic analysis of the small bowel. ⋯ Consider first advising general nutritional improvements. If symptoms persist, involve a trained dietitian for restrictive diets and consider evaluation for small intestinal bacterial overgrowth or other treatments for irritable bowel syndrome.
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Almost all gastrointestinal tract diverticula require no intervention if they are asymptomatic. There is no clear diagnostic modality of choice for diagnosis and surveillance of diverticulum. Medical treatment should be attempted before surgical intervention because significant morbidity is may be associated with resection.
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Irritable bowel syndrome is a common medical condition that significantly alters patient quality of life and presents a series of diagnostic and treatment challenges to the treating provider. This article provides an updated and straightforward overview of the disease, its pathophysiology, diagnosis, and treatment options.
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Gastroesophageal reflux disease (GERD) is a gastrointestinal motility disorder that results from the reflux of stomach contents into the esophagus or oral cavity resulting in symptoms or complications. The typical symptoms of GERD are heartburn and regurgitation of gastric contents into the oropharynx. ⋯ GERD is a clinical diagnosis and is most effectively treated with proton-pump inhibitors (PPIs). Long-term use of PPIs is associated with bone fractures, chronic renal disease, acute renal disease, community-acquired pneumonia, and Clostridium difficile intestinal infection.
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Dementia represents one of the most important and growing public health issues facing society today. Primary care clinics serve a crucial role as the first line of defense in the recognition and treatment of dementia. ⋯ Diagnostic workup should include screening for medical and nondegenerative causes of cognitive impairment that may be remedial. Treatment approaches should include multimodal approaches to address cognitive decline and behavioral/psychiatric symptoms of dementia in an effort to maximize quality of life for both patients and caregivers.