10-08-2010, 10:01 PM
13. A 47‐year‐old woman returns to the office because of gastrointestinal symptoms. She says, "I still have burning pain in my stomach that travels up my chest to my neck after I eat." During the past 5 years she has been treated with antacids, H2‐blocking medications, proton pump inhibitors and motility agents, with only mild relief. She smokes one pack of cigarettes per day and drinks one cup of coffee in the morning. There is no family history of peptic ulcer disease. Previous endoscopies, the last of which was 6 months ago, have shown lower esophagitis secondary to reflux with healing ulcers and scarring. Gastric and duodenal cultures for Helicobacter pylori have been negative. Vital signs today are normal. Physical examination, including rectal examination, is normal. Which of the following is the most appropriate next step?
A ) Consider an alternative pharmacotherapeutic regimen
B ) Continue current treatment
C ) Do esophageal pH monitoring
D ) Obtain surgical consultation
E ) Repeat endoscopy
A ) Consider an alternative pharmacotherapeutic regimen
B ) Continue current treatment
C ) Do esophageal pH monitoring
D ) Obtain surgical consultation
E ) Repeat endoscopy
