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Section 6: Gastrointestinal Disorders

Which of the following represents an extraesophageal GERD symptom?

A. Regurgitation

B. Chronic cough

C. Dysphagia

D. Heartburn

E. Polyps

The answer is B. Examples of extraesophageal GERD symptoms include chronic cough, asthma, or hoarseness. See section “Clinical Presentation” for a complete discussion on the types of GERD symptoms.

A 52-year-old male patient presents to his primary care physician and reports bothersome heartburn symptoms for the last 4 months with occasional regurgitation. The patient reports that the heartburn symptoms are occurring most days of the week. The patient is also happy to report that he has lost 24 pounds (11 kg) in the last several months despite making few changes in his diet or lifestyle. What is the most appropriate recommendation for management of the patient’s heartburn symptoms?

A. Initiate omeprazole 20 mg daily

B. Encourage lifestyle modifications initially

C. Recommend endoscopy

D. Initiate omeprazole 20 mg twice daily

E. Recommend antireflux surgery

The answer is C. Endoscopy is indicated in patients who present with alarm symptoms such as weight loss, dysphagia, odynophagia, or bleeding. See section “Clinical Presentation” (Diagnostic Tests) section of the chapter for additional information.

A 42-year-old male patient with typical GERD symptoms occurring 4-5 days per week has been recently initiated on once daily PPI therapy. The patient reports that his heartburn symptoms are most prominent overnight. The patient has no other medical history and his BMI is 22 kg/m2. Per the American College of Gastroenterology guidelines which of the following represents the best lifestyle modification to recommend for this patient?

A. Elimination of all potential trigger foods in his diet

B. Elevation of the head of the bed (not with pillows)

C. Calorie restriction to lose 10% of his body weight

D. Avoiding meals within 2-3 hours of bed

E. Both B and D

The answer is E. The American College of Gastroenterology guidelines recommend elevation of the head of the bed and avoidance of meals 2-3 hours before bedtime in patients with nocturnal GERD. Weight loss is recommended in those that are overweight and routine global elimination of trigger foods is not recommended. ...

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