A 46-year-old male complains of chest pain described as pain in his mid-chest for the past couple of months that has progressively worsened over the last couple of weeks. He states it has worsened when he goes to bed at night or eats a large meal.

Gastroesophageal Reflux Disease (GERD)

After reviewing this patient’s history and physical assessment, the most probable diagnosis is gastroesophageal reflux disease (GERD). GERD is a condition that occurs when acid from the stomach goes up to the esophagus, and it is a prevalent condition. GERD occurs due to the relaxation of the lower esophageal sphincter, allowing stomach acid and pepsin reflux into the esophagus (Stein, 2020). GERD results in heartburn. Heartburn happens when reverse peristalsis causes backflow of stomach acid into the esophagus. Precipitating factors of heartburn include anatomical abnormalities, nervous tension, and improper diet (Stein, 2020).

This patient is at a high risk of developing obesity due to eating large meals and obesity. He is experiencing GERD symptoms such as sternal chest pain, which is gradually worsening; the sternal chest pain worsens on lying down or after eating a large meal (Stein, 2020). The physical examination reveals normoactive bowel sounds, mild epigastric tenderness, and no hepatosplenomegaly, consistent with GERD (Stein, 2020). This patient’s three possible differential diagnoses would be acute gastritis, peptic ulcer disease, and gastric adenocarcinoma—all these three conditions present with sternal chest pain (Silvia et al., 2018).

An upper GI endoscopy will be ordered to confirm the diagnosis of GERD (Stein, 2020). A thin tube with an endoscope will be inserted down the throat to examine the esophagus and the stomach lining. Other test results may be expected even when acid reflux is present, but an upper GI endoscopy will detect esophagus inflammation and other complications. After confirmation, a patient-centered care plan will be implemented to manage this patient.

The management for this patient will involve the administration of proton pump inhibitors. PPIs help to reduce acid secretion in the stomach (Stein, 2020). These medications are more potent than H2- H2-receptor blockers and will allow the damaged esophageal lining to heal. Even though these medications are well tolerated, careful monitoring is required since long-term use may not benefit the patient. The patient will be given omeprazole 20mg BD for two weeks, then a follow-up visit after two weeks. If the patient does not improve, he will be referred to a gastroenterologist. In addition, the patient will be advised on lifestyle modifications such as a healthy diet, eating small quantities of food, physical activity, weight loss, reducing alcohol consumption, and avoiding drugs that irritate the gastric walls. In addition, you will be advised to elevate the head of the bed. Elevating the head of the bed will ensure no acid reflux.

References

Silvia, C., Serena, S., Chiara, M., Alberto, B., Antonio, N., Gioacchino, L., … & Francesco, D. M. (2018). Diagnosis of GERD in typical and atypical manifestations. Acta Bio Medica: Atenei Parmensis, 89(Suppl 8), 33.