Case Presentation
G.S. is a 44-year-old man who presented to his family physician with a complaint of worsening episodic heartburn and regurgitation over the past several months. He denies any alarm signs or symptoms (Table 1) or any extraesophageal symptoms (Table 2). He does admit to smoking nearly a pack of cigarettes daily since his teenage years, he consumes one to two alcoholic beverages nightly, and admits to eating fatty and spicy foods regularly. He admits that he has decreased his cigarette and alcohol consumption over the past few months and has tried to modify his diet, but has not noticed a favorable improvement in his symptoms.
Upon the urging of a friend, he has tried both over-the-counter (OTC) H2RAs and Prilosec OTCÒ sporadically, but does not want to commit to taking medications long-term, as he has recently heard of potential risks associated with these medications.
Table 1. Alarm Signs and Symptoms of GERD*
Black or bloody stools
Choking
Chronic coughing
Dysphagia
Early satiety
Hematemesis
Hoarseness
Iron-deficiency anemia
Odynophagia
Weight loss
Table 2. Extraesophageal Symptoms of GERD*
Aspiration
Asthma
Chronic cough
Dental enamel loss
Globus sensation
Non-cardiac chest pain
Recurrent laryngitis
Recurrent sore throat
Subglottic stenosis
* If your patients experience any of the alarm signs or symptoms associated with GERD, they should be promptly referred to a gastroenterologist for an endoscopic evaluation.