GERD

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Prep4USMLE Forum » USMLE Step 2 CK Forum » Internal Medicine Forum

GERD

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9 Posts

MDcooper
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09/22/06 - 02:00 PM

a 41 yr old man presents with the complaints of intermittent heartburn after meals for the past 6 months.He has tried various over the counter antacids and H2 blockers but with minimal effects.He denies any dysphagia or odynophagia and is otherwise in good health.He is concerned about the risk of cancer bcz his father died of gastric cancer at age 49.His physical is unremarkable.Which of the following would be the most appropriate next step in management?

A.avoidance of high protien diet

B.Avoidance of aspirin

C.Avoidance of acetaminophin

D.elevation of head of the bed

E.increased consumptionof carbohydrates

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yasmeen
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09/22/06 - 02:02 PM

robin082006
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09/22/06 - 02:20 PM

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MDcooper
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09/22/06 - 02:41 PM

yes raising the head of the bed is right.before starting any medications ,we should go for the life style modifications.Although I dont get it why in the presence of cancer family history and failure of medications,still life style modification is the first approach as patient is at risk of cancer.and why does aspirin avoidance not a good first choice?????

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ssrpk
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09/22/06 - 04:50 PM

not considering the options, my gut instinct would say PPI, but definitely life style modification does'nt make any sense, as the question does'nt specifically says nocturnal complaints!

i would hate to lose marks over a question like this!

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saadtazjam
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09/22/06 - 08:09 PM

Non Compliance with medications????Hence can we advice life style modification???it seems appropriate particularly in this case where there is no dysphagia????

tolito
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09/22/06 - 08:39 PM

i think none of the other options are impliated per se in GERD which appears to be the patients diagnsis.

of all the choices, d appears to be the best option but frankly, the next step would actually be to rule out barett's or gastric cancer in him by endoscopy and then confirm the GERD after that.

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study_ing
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09/24/06 - 11:02 PM

agree with tolito. i was loking for n option to rule out cancer.

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zeloc
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09/15/07 - 05:33 PM

So to confirm, if there is failure of medications for symptoms of GERD, first do endoscopy, and if that is negative, then do the 24 hour pH monitoring?

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