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  • GERD
  • Reflux esophagitis

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  • 530.81 Esophageal reflux

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  • 315.4 Developmental coordination disorder
  • 718.45 Contracture of joint, pelvic region and thigh
  • 719.70 Difficulty in walking
  • 728.2 Muscular wasting and disuse atrophy, not elsewhere classified
  • 728.89 Disorders of muscle, ligament, and fascia
  • 729.9 Other and unspecified disorders of soft tissue
  • 780.7 Malaise and fatigue
  • 781.2 Abnormality of gait
  • 782.3 Edema
  • 786.0 Dyspnea and respiratory abnormalities
  • 786.05 Shortness of breath

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  • K21.9 Gastro-esophageal reflux disease without esophagitis

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  • As of November 2012, the APTA Guide to Physical Therapist Practice does not include practice patterns for organ system pathology; therefore, the associated or secondary musculoskeletal, cardiovascular/pulmonary, or potential neuromuscular patterns would be indicated.

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Description

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  • Condition in which stomach acid backs up into esophagus
  • Patients experience burning feeling in abdominal, chest, or throat areas
  • Common symptom and complaint is “heartburn”

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Essentials of Diagnosis

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  • Acid reflux or indigestion, minimum twice weekly1
  • Inability to or difficulty with swallowing
  • Burning in chest
  • Hoarseness
  • Sore throat
  • Regurgitation of food or sour liquid (acid reflux)
  • Complaint of lump in throat
  • Cough without mucous production or congestion
  • Chest pain
  • Nausea, vomiting

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General Considerations

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  • Broad array of GI disorders may be encountered by physical therapists
  • While PT may not manage GI disorders specifically, clients may receive care for secondary problems: weakness, gait abnormalities, limited aerobic endurance, sarcopenia, musculoskeletal/ neuromuscular problems, weight loss/gain
    • Problems may be acute, post-operative, chronic, viral, bacterial, or congenital/hereditary
  • PT should recognize possible GI pathology in differential diagnosis, especially when findings are inconsistent with conditions commonly treated
  • GI disorders frequently refer pain to other body areas; individuals may be inappropriately referred to PT
  • History of heartburn or indigestion may indicate GI or cardiac problems
  • May lead to more serious conditions such as Barrett’s esophagus
  • May increase risk of cancer or ulcer

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Demographics

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  • GI disorders occur throughout lifespan (birth through geriatric)
  • 55 to 60% of general population suffer from occasional symptoms of GERD2
  • Some indication of genetic tendency
  • Depending on the pathology, occurrence rates may differ based on ethnicity, diet, lifestyle, gender, age
  • High incidence in general population due to potential for lifespan occurrence

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Signs and Symptoms

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  • Chronic indigestion
  • Burning in throat, heartburn
  • Relief with antacids
  • Indigestion at least twice weekly
  • Symptoms worsen when lying flat
  • Wheezing
  • Hiccups
  • Difficulty swallowing (related to esophageal or oral problems rather than neuromuscular)
  • Pain
    • Abdominal/stomach pain, cramping (constant or intermittent, severe)
    • Chest pain
    • Pain upon ingesting food or liquid
      • May be cardiac in nature
    • Pain after ingesting fatty foods (gallbladder sign)
  • Bowel changes
    • Diarrhea (acute, chronic)
    • Constipation (acute, chronic), especially with antacid ingestion
    • Occult blood in stool
    • Change in stool odor or color
    • Mucous in stool or mucous discharge
  • Unexplained weight loss
  • Abdominal muscle spasm, guarding
  • Fatigue
  • Loss of appetite, cachexia, complaints of “feeling full” regardless ...

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