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Esophagogastroduodenoscopy
18%
2/11
Nissen fundoplication
Omeprazole
64%
7/11
Pantoprazole, sucralfate, and amoxicillin
0%
0/11
Ranitidine
Select Answer to see Preferred Response
The patient is presenting with burning chest pain after meals that is improving partially with lifestyle changes suggesting a diagnosis of gastroesophageal reflux disease (GERD). After lifestyle measures, a proton pump inhibitor (PPI) such as omeprazole is appropriate treatment. GERD classically presents in overweight individuals who smoke/drink alcohol with burning epigastric/chest pain after meals. GERD is initially treated with lifestyle interventions such as avoidance of spicy foods, not drinking alcohol, quitting smoking, eating small meals, weight loss, and not lying down after eating. PPIs have been shown to be more efficacious than H2 blockers and are considered the next step in management for GERD when lifestyle changes fail. If medical treatment fails, surgical intervention may be indicated with a procedure called a Nissen fundoplication. Incorrect Answers: Answer 1: Esophagogastroduodenoscopy (EGD) is indicated in patients with alarm signs including dysphagia, odynophagia, weight loss, age > 50, persistent symptoms for many years, or GI bleeding. Answer 2: Nissen fundoplication is a surgical procedure used if medical treatment fails where the gastric fundus is secured around the lower esophageal sphincter (LES), thus reinforcing the LES. It is generally the last-line therapy after lifestyle and medical management fails. Answer 4: Pantoprazole, sucralfate, and amoxicillin is triple therapy which could be used to eradicate an H. pylori infection. This patient's symptoms of GERD improving with lifestyle management does not suggest a diagnosis of GERD. GERD by itself/in isolation is not a common symptom of H. pylori. Answer 5: Ranitidine is an H2 blocker which could be used to treat GERD and may be the best initial treatment for GERD/regurgitation in the newborn; however, a PPI is a more effective and a better next step in management in an adult patient. Bullet Summary: The most appropriate initial management of GERD is first lifestyle measures followed by administration of a proton pump inhibitor.
4.2
(6)
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