A 27 year old man presents with a 3 month history of heartburn and epigastric discomfort. His symptoms are exaggerated after meals especially if he eats spicy food. He takes no medications, doesn’t smoke or drink alcohol. He exercises regularly and has an active lifestyle. On physical examination, he has slight epigastric tenderness. His routine lab tests are normal
What is the most appropriate intervention at this time?
A- Barium swallow
B- Esophageal manometry
C- 24-hour pH monitoring
D- Upper endoscopy
E- Trial of a proton-pump inhibitor
The most appropriate intervention is a trial of a proton pump inhibitor. If improvement occurs then, no need to other costly and time consuming investigations.
The correct answer is E
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Thank you Dr Zarsham
If age less than 50 yrs and no danger signs like GIT bleeding wt loss etc, then trial of ppi is given. And if age above 50 with chronic burning or any danger sign then do endoscopy first.
Thank you dear doctor. I appreciate your feedback. I am not sure what do you mean by gerentology?
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We exclude other causes if ppi works.
Shouldnt we exclude other causes of epigastric tenderness before starting ppi ?
In clinical practice in the USA, we try PPI first for 2 weeks, if there is no improvement, then will try other tests. Thanks nabajit for your question and comment.
But in Kaplan medicine there is no need of specific test before PPI indication….can you clear it ?
According to Dr.Farooqi and Schwartz principal of surgery…Achalasia ,diffuse spasm ,eesophageal carcinoma ,pud /dud ,cad ,gastritis ,cholelithiasis these symptoms may arise …so always need a confirmations test before PPI..