By vgreene, 23 December, 2014 Assess w H P including assessment of bladder sx UA to exclude microhematuria and infection CP
By vgreene, 23 December, 2014 Not recommended for initial w u unless diagnostic uncertainty urodynamics cystoscopy urinary tract imaging CP
By vgreene, 23 December, 2014 If dx unclear or more info needed UCx PVR sx questionnaire and or voiding diary CP nbsp nbsp PVR measure w U S bladder scanner immediately post void if U S scanner not available use urethral cath
By rray, 23 December, 2014 Increase PPI dosing<sup>19</sup> to bid or consider a switch to a different PPI<sup>20</sup> [C/L]
By rray, 23 December, 2014 If nocturnal sx, sleep disturbance, &/or variable schedules: consider dose-timing<sup>19</sup> adjustment &/or bid dosing [S/L]. Bedtime H2RA can be added prn to daytime PPI tx for nighttime sx, but tachyphylaxis may occur after several wks of use [C/L].
By rray, 23 December, 2014 First, optimize PPI dose, timing, and drug.<sup>15</sup> Then refer PPI nonresponders for eval [C/L]:
By rray, 23 December, 2014 Not recommended: esophageal manometry [S/L], <i>H. pylori</i> screen [S/L], barium radiographs [S/H]