02-28-2008, 04:57 PM
A 65-year-old man comes to the clinic for his annual examination. On review of systems, he mentions that he has developed intermittent heartburn over the past 2 months. He describes his heartburn as a fullness or soreness in his stomach, which is occasionally related to meals, though it sometimes occurs with hunger. He has a mild sense of nausea with the discomfort, but no vomiting or stool changes. He feels œgassy, and sometimes he feels like food is stuck in his chest, although he has no difficulty swallowing solids or liquids when eating. The symptoms have been keeping him up at night, prompting him to come see you. Review of symptoms also reveals an unintentional weight loss of 10 lb over the past few months. Reviewing the patient™s medications, you realize he has been taking a large daily dose of naproxen for joint pain. Vital signs are: blood pressure 140/80 mm Hg, pulse 88/min, respirations 20/min, and temperature 37 C (98.6 F). Physical examination is unremarkable. In addition to changing his naproxen for acetaminophen, which of the following is the most appropriate management?
A. Empiric trial of a proton-pump inhibitor (PPI)
B. Misoprostol to speed healing of NSAID-induced gastropathy
C. Test stool for H. pylori; treat if positive
D. Trial of an H2-blocker; PPI if no response
E. Urgent endoscopy (EGD) with possible biopsy
A. Empiric trial of a proton-pump inhibitor (PPI)
B. Misoprostol to speed healing of NSAID-induced gastropathy
C. Test stool for H. pylori; treat if positive
D. Trial of an H2-blocker; PPI if no response
E. Urgent endoscopy (EGD) with possible biopsy