A 42-year-old man comes to the clinic complaining of a burning sensation in his chest that radiates toward his neck. He states that these symptoms occur 3 to 4 times a week and have been present for the past 2 months. The discomfort typically worsens after large meals and when lying down at night. He frequently experiences a sour taste in his mouth. He denies difficulty swallowing, pain with swallowing, unexplained weight loss, nausea, vomiting, or dark stools. His past medical history is unremarkable, and he takes no daily medications. Vital signs are within normal limits, and physical examination shows a non-tender, non-distended abdomen. Which of the following is the most appropriate next step in the management of this patient?
- Trial of a daily proton pump inhibitorAnswer
- BEsophagogastroduodenoscopy
- CAmbulatory 24-hour esophageal pH monitoring
- DBarium esophagram
- EUrea breath testing for Helicobacter pylori
Answer
Trial of a daily proton pump inhibitor
This patient presents with classic symptoms of gastroesophageal reflux disease (GERD), which include retrosternal burning (heartburn) and regurgitation (sour taste). According to current clinical guidelines, patients with typical GERD symptoms who lack alarm features (e.g., dysphagia, odynophagia, unintentional weight loss, anemia, gastrointestinal bleeding) should undergo an empiric trial of a proton pump inhibitor (PPI) once daily for 8 weeks. This approach is both diagnostic and therapeutic. Invasive diagnostic testing is not warranted at this initial stage.
Step-by-Step Solution
Key Concept
Patients presenting with typical symptoms of gastroesophageal reflux disease (GERD) and no alarm symptoms should be treated with an empiric 8-week trial of a proton pump inhibitor.