A 35 year old man presents in your clinic complaining of substernal chest pain and a metallic taste in mouth. He has been having this pain for the past few months and usually starts when he take heavy oily meals. You suspect GERD (gastroesophageal reflux disease).
Answer the following questions.
Q 1. What are the alarming signs and when should one perform endoscopy in a patient with suspected GERD?
Answer: The following symptoms should be considered serious and an endoscopy should be performed:
Q 2. Which is the first step in diagnosis?
Answer: Starting treatment with PPIs is both the first step in diagnosis and treatment. Further testng should only be done if there is no response to PPI therapy.
Q 3. Outline the management steps?
Answer:
1. Mild disease can be controlled with life style modifications that include:
- Losing weight
- Elevating the head end of the bed
- Quit smoking
- Limit caffeine and chocolate in diet
- Avoid alcohol
- Avoid eating within 3 hrs of going to sleep
2. Proton pump inhibitors: are one of the best choice for managing GERD.
3. H2 receptor blockers: can be used if PPIs are not available
4. Referral for surgical procedures is done in patients who do not respond to medicines at all.
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