04-28-2006, 04:32 PM
Next step to take care of a middle aged pt with GI symptoms, experiencing burning pain in stomach that travels up the chest to the neck after eating, having been treated with antacids, H2 blocking medications, proton pump inhibitors and motility agents for 5 yrs, smoking 1 pk of cigarettes per day and drinking 1 cup of coffee in the morning, no familiy hx of peptic ulcer dis, a 6 month ago lower esophagitis secondary to reflux with healing ulcers and scarring via endoscopies, negative gastric and duodenal cultures for H. pylori, normal vital signs, normal PE, and rectal exam?
1. Repeat endoscopy
2. Do esophageal pH monitoring
3. Continue current tx
4. Obtain surgical consultation
5. Consider an alternative pharmacotherapeutic regimen
1. Repeat endoscopy
2. Do esophageal pH monitoring
3. Continue current tx
4. Obtain surgical consultation
5. Consider an alternative pharmacotherapeutic regimen