GERD: The Daily PANCE Blueprint
A 52-year-old male presents to the clinic complaining of “sharp burning” in his lower chest after eating a large meal. The pain goes away when he raises the head of the bed. Which of the following is the best pharmacological agent for this likely diagnosis?
A. Esomeprazole
B. Nitroglycerin
C. Aspirin
D. Codeine
E. Sucralfate
Answer and topic summary
The answer is A. Esomeprazole
The patient has gastrointestinal reflux disease (GERD), which is a common condition characterized by stomach acid flowing up into the esophagus. Classic symptoms include heartburn (burning sensation around the sternum) after eating, water brash, regurgitation, and dysphagia.
The diagnosis is usually clinical; however, if the patient has alarming symptoms (e.g., weight loss, anemia, etc), it is appropriate to get an upper endoscopy. The gold standard is an ambulatory 24-hour pH monitoring system. Initial management includes weight loss, elevating the head of the bed, and eliminating triggers (spicy foods, chocolate, etc). Most recommend starting with histamine 2 receptor antagonist therapy first (e.g., ranitidine) and then transitioning to proton pump inhibitors (e.g., esomeprazole).
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint GI and Nutrition ⇒ ⇒
Also covered as part of the Family Medicine EOR, Internal Medicine EOR, and Pediatric EOR topic list
