{
  "schema_version": 1,
  "kind": "condition",
  "id": "dysphagia-referral",
  "name": "Dysphagia Primary Care Initial Management & Referral",
  "category": "chronic",
  "sources": "ACG Clinical Guideline: Diagnosis and Management of Esophageal Motility Disorders 2020 · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (omeprazole monograph)",
  "review_status": "reviewed",
  "verified_against": "Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (omeprazole monograph) · Dysphagia - disease-level clinical article (dysphagia-referral-clinical.txt)",
  "verified_date": "2026-08",
  "treatments": [
    {
      "id": 649,
      "generic": "Omeprazole",
      "line": 1,
      "is_adjunct": false,
      "form": "oral.solid",
      "strength_mg": 20.0,
      "adult_dose": "20-40 mg once daily 30 minutes before breakfast",
      "adult_duration": "Until urgent endoscopic evaluation",
      "dose_source": "Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (omeprazole monograph)",
      "rationale": "Empiric trial for peptic stricture / reflux dysphagia while urgent upper GI endoscopy referral is arranged",
      "cautions": [
        "URGENT REFERRAL MANDATORY: Dysphagia is a red-flag symptom requiring urgent upper GI endoscopy to exclude esophageal carcinoma or stricture.",
        "Do not delay diagnostic endoscopy while prescribing PPI.",
        "Advise soft/liquid diet and thorough chewing while awaiting evaluation."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Specialist pediatric gastroenterology referral required for paediatric dysphagia",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [
        {
          "trade_name": "OMEGASTAZOLE 20MG 14 CAPS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "RIVA PHARMA S.A.E.",
          "price_egp": 18.0,
          "pack_count": 14,
          "unit_price": 1.29,
          "strength_mg": 20.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "OMEPRAL 20MG 14 CAPS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "MEMPHIS",
          "price_egp": 32.0,
          "pack_count": 14,
          "unit_price": 2.29,
          "strength_mg": 20.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "RISEK 20 MG 28 CAPS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "JULPHAR",
          "price_egp": 75.0,
          "pack_count": 28,
          "unit_price": 2.68,
          "strength_mg": 20.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "OMISEC 20MG 14CAPS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "THE UNITED PHARMACEUTICALS CO LTD-JORDAN > MODERN PHARMA",
          "price_egp": 42.0,
          "pack_count": 14,
          "unit_price": 3.0,
          "strength_mg": 20.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "EPIRAZOLE 20MG 14CAPS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "EIPICO",
          "price_egp": 44.0,
          "pack_count": 14,
          "unit_price": 3.14,
          "strength_mg": 20.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "OMEPAK 20 MG 14 CAPS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "SEDICO",
          "price_egp": 50.0,
          "pack_count": 14,
          "unit_price": 3.57,
          "strength_mg": 20.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "RISEK 20 MG 14 CAPS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "JULPHAR",
          "price_egp": 57.0,
          "pack_count": 14,
          "unit_price": 4.07,
          "strength_mg": 20.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "NAPIZOLE 20MG 14 CAPS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "GLOBAL NAPI PHARMACEUTICALS",
          "price_egp": 62.0,
          "pack_count": 14,
          "unit_price": 4.43,
          "strength_mg": 20.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "dysphagia-referral"
    },
    {
      "id": 650,
      "generic": "Referral & safety-netting (no drug therapy)",
      "line": 1,
      "is_adjunct": false,
      "form": null,
      "strength_mg": null,
      "adult_dose": null,
      "adult_duration": null,
      "dose_source": "Dysphagia - disease-level clinical article (dysphagia-referral-clinical.txt)",
      "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.",
      "cautions": [
        "RED FLAG - Alarm features of malignancy (weight loss, bleeding, smoking/alcohol history) accompanying dysphagia require urgent head/neck or GI evaluation, not just an empiric PPI trial.",
        "RED FLAG - Progressive (vs intermittent) dysphagia is a specific red flag suggesting stricture or malignancy rather than a benign/motility cause.",
        "RED FLAG - Oropharyngeal dysphagia (difficulty initiating swallowing, coughing/choking, nasal regurgitation - often neurological, eg stroke) must be distinguished from esophageal dysphagia before treatment, since it carries aspiration risk and needs speech-pathology/ENT/neuro referral rather than a GI-endoscopy-linked PPI trial."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": null,
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [],
      "condition_id": "dysphagia-referral"
    }
  ]
}