The etiology of perianal itching is not just worm and other causes such as retained smal of stool around anus after whipping following bowel movement, allergy , hemorrhoid , anal fissure and some systemic diseases can present with perianal itching. Pinworm is the most common parasitic etiology for this problem. Mebendazole therapy and following strict hygiene guidelines such as washing underwears and bed sheets with hot water can solve the problem although it may recur occasionally if somebody else it your household carrying the parasite.
There are other medication such as Albendazole which can be used for other parasites such as hookworms.
Also, if you are at a high risk for hearing disease, getting a baseline EKG and even stress test if indicated by your family doctor in case the medication does not work will be reasonable.
There’s times when acid reflux can be cured if it's related to sudden weight gain, smoking, or drinking too many caffeinated beverages after correcting these factors. Most acid-reducing medications are safe in the long term and most side effects have been rejected in more detailed studies. It is advisable to avoid any medication including acid-reducing meds if potential side effects outweigh the benefit of relieving occasional reflux episodes that can be managed with an on-demand approach to take it when you have symptoms if it is not persistent and does not return as soon as you stop the medication. Ignoring symptoms of severe and persistent acid reflux disease to avoid potential unproven side effects is not wise. It will affect your quality of life and increase the chances of complications such as narrowing of the esophageal lumen due to scar tissue formation, ulcer, bleeding, and possible developement of esophageal cancer.
The presence of constipation increases fermentation of colonic content by bacteria, which contributed to gas formation and bloatness and will improve by treatment for constipation.
In elderly people, the presentation of GERD may be more subtle and they may present with complications of GERD such as luminal narrowing due to scar tissue formation with trouble swallowing or precancerous lesions called Barrette’s esophagus, which is the development of intestinal tissue replacing normal lining layer of esophagus.
In younger people, particularly young children, nausea and vomiting as well as poor appetite are more common symptoms compared to adults who present with classic symptoms of GERD.
Other less frequent symptoms are trouble swallowing and atypical chest pain as well as hoarseness with sore throat with occasional dental caries.
To diagnose GERD, we can try to treat the patient with typical symptoms.
Other diagnostic tests include endoscopy looking for pathological damage on biopsy or more specific and specialized tests such as pH monitoring.
In pH monitoring, we measure 48 hr acid exposure in the lower esophagus by placement a small device in the esophagus while the patient charts his or her symptoms carrying a belt which receives signals from the device.
These tests are more appropriate for the people who do not respond to acid reducing therapy for 4 weeks or have atypical symptoms.
Also, any patient with alarm symptoms with GERD such as bleeding, low blood count, trouble swallowing and weight loss, endoscopy should be done initially before empirical therapy with acid reducing medication.
During Endoscopy, only 50 percent of people have evidence of tissue damage to esophagus and the remaining 50 percent have normal esophagus who need more specialized tests as was mentioned to diagnose GERD.
It is noteworthy to remember there is a large number of individuals who have depression or other underlying emotional disorders who do not respond to therapy and all their tests will be normal who might benefit from anti-depressive medications.
We also should keep in mind people with motility disorder such as Achalasia, which is inadequate relaxation of the sphincter between the esophagus and stomach, causing trouble swallowing, and food allergy called eosinophilic esophagitis can manifest with reflux symptoms, but the underlying mechanisms are different from GERD.
Interstingly, half of people with eosinophilia esophagitis also respond to strong medication used for acid reduction in esophagus before considering food elimination or using inhalar steroid.
The most common cause of intermittent swallowing difficulty is food allergy which is called Eosinophilic Esophagitis diagnosed by endoscopy and biopsy being treated by avoiding six most known culprits such as milk, wheat, nuts. The therapy with inhaler steroids in resistant cases followed by gentle dilatation of esophagus in the case of luminal narrowing is recommended.