Case !

W.J. is a 39-year-old, 130-kg, 67-inch-tall man who presents with complaints of indigestion. He
describes a burning sensation behind his breastbone and some belching that is often associated
with an acid taste in the back of his mouth. He indicates that his symptoms began a few months
ago, and they only occur a few times a month, especially after eating large or spicy meals. Also, if
he eats too close to his bedtime, the burning keeps him up at night. He has used liquid antacids in
the past for these symptoms and states they work fairly well, but he has to take frequent doses, as
the symptoms return quickly. He asks if there is something that he could take to prevent his
symptoms. He does not take any other medications. Which of W.J.s symptoms are consistent with
GERD?
What are the therapeutic goals for the treatment of W.J.s GERD?
What lifestyle and dietary changes may potentially reduce W.J.s GERD symptoms?
Which OTC treatment options (if any) would you recommend for W.J.?
Case 2
L.F. is a 48-year-old woman who presents to her primary care provider complaining of recurrent
heartburn occurring daily for the past 6 weeks. She states that the heartburn occurs frequently
after meals and often wakens her at night. Lately, she has been experiencing difficulty swallowing
solid foods. L.F. currently smokes two packs of cigarettes per day and likes to have a glass of wine
each night before bedtime. She states that she occasionally uses OTC ranitidine 150 mg orally up
to twice daily, which temporarily relieves her symptoms. What diagnostic modalities are available
for the evaluation of her GERD?
L.F.s frequent severe symptoms continue despite full-dose OTC H2 RA therapy and the presence
of warning signs warranted that she undergo endoscopy, which revealed moderate esophagitis
(Los Angeles grade C), the presence of an esophageal stricture, and no evidence of Barretts
metaplasia. Esophageal dilation was performed during the procedure to widen the lumen of the
esophagus. What treatment options exist for L.F.?
L.F.s symptoms resolved in about 2 weeks after starting PPI therapy, and she remained
asymptomatic after 8 weeks. She then underwent endoscopy again, which revealed that the
esophagus had healed completely. Her primary care physician then stopped the PPI. Now, 2 weeks
later, she is experiencing mild heartburn. Is L.F. a candidate for long-term maintenance therapy?