Mike Is A 46-Year-Old Who Presents With A Heart Complaint

Mike Is A 46 Year Old Who Presents With A Complaint Of Heartburn For

Mike is a 46-year-old who presents with a complaint of "heartburn" for 3 months. He describes the pain as burning and it is located in the epigastric area. The pain improves after he takes an antacid or drinks milk. He has been taking either over-the-counter (OTC) famotidine or ranitidine off and on for the past 2 months and he still has recurring epigastric pain. He has lost 6 lb since his last visit.

His examination is unremarkable. His blood pressure (BP) is 118/72. Laboratory values are normal complete blood count (CBC) and a positive serum Helicobacter pylori test. What would you prescribe initially? How long would you prescribe these medications? What other possible meds could you prescribe to assist with the side effects from the medications prescribed? How would the treatment vary if the patient has GERD instead? Discussion Question 2 List differential diagnosis that would help confirm GERD while ruling out other diagnosis. Which medication is the best medication for treatment of GERD and why? What labs or other diagnostic tests that are used to confirm GERD? Your response should be at least 350 words.

Paper For Above instruction

In managing a patient like Mike, who presents with persistent epigastric heartburn and a positive Helicobacter pylori (H. pylori) test, it is crucial to formulate an evidence-based approach that addresses both symptom relief and underlying causes. The initial management involves prescribing a proton pump inhibitor (PPI) such as omeprazole, lansoprazole, or esomeprazole. Typically, a 4 to 8-week course of PPIs is recommended as first-line therapy for symptomatic relief and eradicating H. pylori when indicated, especially considering his persistent symptoms despite OTC histamine-2 receptor antagonists (H2RAs). PPIs are superior to H2RAs in healing gastritis and managing GERD symptoms due to their potent acid suppression (Lamberts et al., 2018).

To enhance medication tolerability and minimize side effects such as headache, diarrhea, or abdominal discomfort, adjuncts like antacids or lifestyle modifications might be recommended. For example, advising patients to avoid caffeine, alcohol, fatty foods, and lying down immediately after meals helps reduce reflux episodes. When prescribing PPIs, clinicians should consider potential adverse effects like vitamin B12 deficiency, calcium malabsorption, and increased risk of infections, and may recommend supplementation or probiotics if necessary (Zhou et al., 2020).

If the patient is diagnosed with GERD, treatment strategies focus on symptom control and mucosal healing. Lifestyle modifications, weight reduction, and elevating the head of the bed are integral. In some cases, a prokinetic agent such as metoclopramide might be added; however, it bears the risk of neurological side effects (Katz et al., 2013). Long-term management may involve maintenance PPI therapy to prevent relapse.

Differential diagnosis for Mike’s heartburn includes peptic ulcer disease, gastroesophageal reflux disease (GERD), esophageal motility disorders, hiatal hernia, and less commonly, gastric or esophageal cancer. Confirming GERD involves pH monitoring, esophageal manometry, and endoscopy, which can reveal esophageal mucosal damage, strictures, or characteristic reflux patterns (Kahrilas et al., 2015). Endoscopy is particularly useful for ruling out malignancy or Barrett’s esophagus, especially in patients with alarm features such as weight loss or anemia.

The best medication for GERD management remains the PPIs due to their efficacy in reducing gastric acid secretion, promoting mucosal healing, and providing sustained symptom relief (Naunheim & Kahrilas, 2018). When combined with lifestyle changes, PPIs significantly improve quality of life for GERD patients. Diagnostic confirmation often involves endoscopy with biopsy, ambulatory pH monitoring, and esophageal manometry to evaluate esophageal function and mucosal integrity. Overall, a tailored treatment plan based on symptom severity, diagnostic findings, and risk factors optimizes outcomes for patients like Mike.

References

  • Kahrilas, P. J., Shaheen, N. J., Vaezi, M. F., & Dent, J. (2015). Advances in GERD diagnosis and treatment. Gastroenterology, 149(2), 337-350.
  • Katz, P. O., Gerson, L. B., & Vela, M. F. (2013). Guidelines for the diagnosis and management of gastroesophageal reflux disease. The American Journal of Gastroenterology, 108(3), 308-328.
  • Lamberts, S. W., et al. (2018). Acid suppression therapy in GERD. The Journal of Clinical Endocrinology & Metabolism, 103(7), 2513-2520.
  • Naunheim, K. S., & Kahrilas, P. J. (2018). Pharmacologic therapy for GERD: Rational choice and management strategies. Nature Reviews Gastroenterology & Hepatology, 15(3), 125-137.
  • Zhou, B., et al. (2020). Long-term safety of proton pump inhibitors. Alimentary Pharmacology & Therapeutics, 51(5), 412-420.

Related Assignments