American family physician
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Endometriosis is an inflammatory condition caused by the presence of endometrial tissue in extra-uterine locations and can involve bowel, bladder, and all peritoneal structures. It is one of the most common gynecologic disorders, affecting up to 10% of people of reproductive age. Presentation of endometriosis can vary widely, from infertility in asymptomatic people to debilitating pelvic pain, dysmenorrhea, and period-related gastrointestinal or urinary symptoms. ⋯ All of these treatments are effective but may cause additional adverse effects. Referral to gynecology for surgical management is indicated if empiric therapy is ineffective, immediate diagnosis and treatment are necessary, or patients desire pregnancy. Alternative treatments have limited benefit in alleviating pain symptoms but may warrant further investigation.
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About 60% of adults in the United States have one or more diet-related chronic diagnoses, including cancer, cardiovascular and cerebrovascular diseases, diabetes mellitus, and obesity. It is imperative to address nutrition health in the clinical setting to decrease diet-related morbidity and mortality. Family physicians can use validated nutrition questionnaires, nutrition-tracking tools, and smartphone applications to obtain a nutrition history, implement brief intervention plans, and identify patients who warrant referral for interdisciplinary nutrition care. ⋯ Department of Agriculture 2020-2025 Dietary Guidelines for Americans when assessing patient nutrient intake quality and pattern; however, it is also essential to assess nutrition health within the context of an individual patient. It is important to maintain a basic understanding of popular diet patterns, although diet pattern adherence is a better predictor of successful weight loss than diet type. Using various counseling and goal-setting techniques, physicians can partner with patients to identify and develop a realistic goal for nutrition intervention.
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Barrett esophagus is a premalignant change of the esophagus; however, malignant transformation to esophageal adenocarcinoma is rare in patients without dysplasia. Barrett esophagus is estimated to affect up to 5.6% of the U. S. population. ⋯ Patients with Barrett esophagus should be offered proton pump inhibitor therapy to control reflux symptoms and possibly decrease the risk of developing esophageal adenocarcinoma. Statins, nonsteroidal anti-inflammatory drugs, and aspirin are associated with a decreased risk of esophageal adenocarcinoma in patients with Barrett esophagus; however, they should not generally be prescribed in the absence of another indication. Mortality benefits of screening and surveillance are uncertain.