A 42-year-old man with a history of diabetes and hypertension presents complaining of "heartburn." He reports a burning sensation in his upper chest and some regurgitation of sour-tasting material into his throat. The symptoms began about 1 month ago, occur about twice a week, and are associated with heavy meals and lying down after eating. He says that he smokes about one pack of cigarettes per day and drinks coffee and alcohol-containing beverages on most days. His weight is 116 kg (255 1b).
What information is suggestive of GERD?
Does he have any factors contributing to GERD?
What additional information do you need before creating a treatment plan for this patient?
Newer technology involves a camera-containing capsule swallowed by the patient, which can perform noninvasive endoscopy but cannot adequately assess for Barrett's esophagus. The procedure can be performed in the practitioner's office in approximately 15 minutes.
Patients with esophageal GERD syndromes who have failed twice-daily PPI therapy and have normal findings on endoscopy may benefit from manometry. Manometry helps to localize the LES for ambulatory pH monitoring, evaluates peristaltic
function in patients considering surgery, and identifies possible motor disorders.
Ambulatory pH monitoring objectively proves that symptoms are reflux related in patients with esophageal GERD syndromes not responding to twice-daily PPI therapy. Impedance monitoring allows reflux episodes to be characterized as acid or nonacid.9 This method may be useful in patients with refractory symptoms. Duo-denogastroesophageal reflux monitoring may be useful in identifying nonacid reflux
(e.g., bile reflux), especially in patients not responding to twice-daily PPI therapy. It is preferable that PPI therapy be held for 7 days prior to ambulatory impedance pH,
catheter pH, or wireless pH monitoring for best results.
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Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.