Question

A 57-year-old woman, presents to her primary care office with complaints of heartburn, occurring mainly after eating and especially at night. The patient also reports experiencing nausea, regurgitation, and severe burning in her chest after eating spicy food. After a complete physical examination and referral for tests to rule out other causes, the patient is diagnosed with gastroesophageal reflux disease (GERD). You find that her EGD results revealed H.Pylori. The patient also has a history of asthma, and 6 months earlier she fractured her hip following a fall.

• What other subjective information is needed during the visit and why?
• Based on this patient’s diagnosis of H. Pylori, GERD and medical history, discuss what you would advise as effective treatment options for managing her GERD.
• Discuss the associated risk factors of long term use of PPIs.

Answer 1

The subjective information which are needed are

• Is the symptoms worsening when lying down ,because regurgitation is more in supine position
• Complaints of dry cough,sore throat any obstruction in the throat
• Difficult to swallow foods due to muscle weakness in the gastrointestinal tract
• Any complaints of ad breath odour due to over acid secretion

The effective treatment option for this patient are

• Dietary modifications with less spicy ,oily foods
• Antibiotics to treat the H pylori infection
• Proton pump inhibitor to reduce the acid secretion
• Anti diarrheal medications to treat loose stools
• Antacids to balance the pH of the stomach during acid secretion

The associated risk factors for long term use of PPIs are

• It can cause bone loss and increase the risk of fracture as this patient had fracture previously it can affect the patient severely
• The risk of getting decreased calcium, magnesium in the blood, vitamin B12 deficiency
• Can worsen the condition of GERD if stopped
• Pneumonia due to micro aspiration of H.Pylori infection in the stomach and continuous acid suppression into lungs
• Clostridium difficile colitis in long term use
• Acute interstitial nephritis can be seen in patient using PPI for a longer period
• The chance of getting dementia is higher