hallachi
Forum Junior
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40 yr old white male present with the complain of bitter taste and central cheat pain .He further describes the pain as moderate to severe,occurying after the meal .Nonradeating and burning.the pain is relieved with antacids and worsend by lying down.He lost 10 lbs past 5 month.Smoked 2 paks cigerratte daily for 20 years.His vitals are stable.He is afebrile.Physical examination unremarkeable.chest x ray,EKG,Echo are nornal.what is the most appropriate next step in the management?
1treatment with antacids
2.treatment with famotadine
3.treatment with omeprazole
4.esophagoscopy
5.pH monitoring
please ans this with explanations
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| robin082006
Forum Hero
Topics: 471
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GERD, risk of cancer: smoking weight loss
4.esophagoscopy
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| paviraj
Forum Senior
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significant weight loss, smoking, symptoms of gerd ;if given first do barium swallow,then endoscopy; to r/o carcinoma esophagus. smoker=scc,gerd=adeno ca.
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| DrPak
Forum Elite
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Yep, you scope him, see if it's cancer. The wieght loss and risk factors should increase your index of suspicion for cancer.
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| dr_jojo
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i agree with u doctors
in this senario scope 1st
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| hallachi
Forum Junior
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yes you ppl are right ans is endoscopy...
but why not pH monitring first ,to conferm it is Gerd?
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| DrPak
Forum Elite
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pH monitering is a hassle. You need to leave the thing in there for a long time to see if the pH drops during the day (the reflux in GERD is usually episodic). Besides that, GERD is a less serious problem than cancer. You always rule out the serious thing first.
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| hallachi
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thank you Dr Pak ...now i understand..
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| felkhider
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Umm, I don't think that the answer is scoping. For GERD (and peptic ulcer), you should treat imperically with a PPI if the diagnosis is obvious, (like in this case). So I think the answer is omeprazole. Which is number 3. Endoscopy is indicated only if the pt. has GERD for 5 years, or has alarming symptoms (dys/odyno phagia, wt loss, anemia, heme positive stools), and YES, this pt. has been losing wt, but "therapy with a PPI should be initiated immediately"...
Edited by felkhider on 02/16/07 - 02:14 PM
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| DrPak
Forum Elite
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PUD is not an emergency. You'll write the prescription and the guy will go home and take the drugs. Esophascopy is something you can do at the office/hospital, so it's the next best step.
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| krsna
Forum Senior
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esophagoscopy
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| mjl1717
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DrPak wrote:
pH monitering is a hassle. You need to leave the thing in there for a long time to see if the pH drops during the day (the reflux in GERD is usually episodic). Besides that, GERD is a less serious problem than cancer. You always rule out the serious thing first.
Yes step 2ck is a totally different way of thinking from step 1...In actually thinking like a doc,instead of like a basic science master (memorization)... As Dr. Pak is saying always think about the most lethal and the most common but must r/o the most lethal 100%.
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| dannyyro
Forum Newbie
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reflux disease with alarm symptoms (loose weight,anemia, dysphagia, odinophagia,GI bleeding) or recurent symptoms or longer than 5 years are indications for endoscopy with biopsy to rule out cancer/barret esophagus
all others reflux diseases you start treatement, medical plus life change style;
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| cbenitesch
Forum Senior
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I thinks is not only the procedure, I think an upper digestive endoscopy first we need to check for any neoplasm thinking in weight loss, barrte esophagus!... then look for the cause of GERD mostly hiatal hernia... so I think we can conclude this way the study of patient.
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