Description

Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 6th Edition

Esophageal Reflux Case Studies

A 45-year-old woman complained of heartburn and frequent regurgitation of “sour” material into her mouth. Often while sleeping, she would be awakened by a severe cough. The results of her physical examination were negative.

Diagnostic Analysis

The barium swallow indicated a hiatal hernia. Although many patients with a hiatal hernia have no reflux, this patient’s symptoms of reflux necessitated esophageal function studies. She was found to have hypotensive LES pressure along with severe acid reflux into her esophagus. The abnormal acid clearing and the positive Bernstein test result indicated esophagitis caused by severe reflux. The esophagitis was directly visualized during esophagoscopy. Her coughing and shortness of breath at night were caused by aspiration of gastric contents while sleeping. This was demonstrated by the gastric nuclear scan. When awake, she did not aspirate, as evident during the swallowing function study. The patient was prescribed esomeprazole (Nexium). She was told to avoid the use of tobacco and caffeine. Her diet was limited to small, frequent, bland feedings. She was instructed to sleep with the head of her bed elevated at night. Because she had only minimal relief of her symptoms after 6 weeks of medical management, she underwent a laparoscopic surgical antireflux procedure. She had no further symptoms.

Critical Thinking Questions

1. Why would the patient be instructed to avoid tobacco and caffeine?

The patient would be instructed to avoid tobacco and caffeine because these substances can act as irritants that stimulate the production of stomach acid, which can worsen symptoms of gastroesophageal reflux.

2. Why did the physician recommend 6 weeks of medical management?

The physician recommended 6 weeks of medical management in order to allow the patient to assess whether the prescribed medications were having an effect on the symptoms. This time frame also allowed the body to adjust to the medication and for the medications to reach their full therapeutic effect.

Case Studies                                                                                                               

3. How does antacid medication work in patients with gastroesophageal reflux?

Antacid medications work in patients with gastroesophageal reflux by neutralizing the stomach acid that is causing the reflux. This helps to reduce the inflammation in the esophagus and reduce the symptoms of heartburn.

4. What would you approach the situation, if your patient decided not to take the medication and asked you for an alternative medicine approach?

If the patient decided not to take the medication and asked for an alternative medicine approach, it would be appropriate to discuss lifestyle modifications. Lifestyle modifications can also help reduce symptoms of gastroesophageal reflux, such as eating smaller meals, avoiding foods that trigger symptoms such as spicy or fatty foods, avoiding lying down right after eating, and elevating the head of the bed at night. It would also be helpful to discuss stress management techniques that can help reduce reflux symptoms.