NU702
Advanced
Pharmacotherapeutics
Week #10
Case Study: GI system
Complaint: “My heartburn has been
waking me up at night.”
History: Greg is a 47-year-old man
who presents at clinic with complaints of intermittent nocturnal
gastroesophageal reflux. History reveals that he awakens experiencing burning
pain substernally and in the back of his throat. This results in “my larynx
closing down” and his being “almost unable to breathe.” As soon as he can
breathe effectively, he swallows “a lot” of antacid and flushes it down with
water. The entire episode is very frightening, and he is often afraid to go
back to sleep. Because he already has a problem with mild sleep apnea, he is
becoming increasingly tired and unable to function at work due to lack of
sleep. He now sleeps only in his recliner. He is also concerned about the
substernal pain because his father had a myocardial infarction at age 49 and
required coronary artery bypass surgery. He is 5 feet 9 inches tall and weighs
188 pounds (body mass index [BMI] is 27.8), with much of his excess weight
carried in his abdomen. He is not a smoker, “occasionally” has three or four
beers with friends, and “often” has pizza or submarine sandwiches for lunch
with a “diet cola.” He takes no drugs other than the antacid after a reflux
episode.
Assessment: A chest
x-ray and electrocardiogram are negative for cardiopulmonary disease, and Greg
is diagnosed by history with gastroesophageal reflux disease (GERD).
What is
your diagnosis and initial management plan? Please include prescription as you
would write it in practice.
Follow-Up Visit: At his
follow-up visit, Greg states that the number of episodes is much lower and they
are less severe, but he still has had two episodes. Careful history taking
reveals that both of these episodes were related to “lapses” in following the
lifestyle modification. In both cases, he had friends visit, and they had consumed
“three or four” beers each about 1 hour before he went to bed. He still sleeps
in his recliner because “I do not want to have that feeling of not being able
to breathe again.” He continues to report that he does not feel rested upon
awakening in the morning. He has lost 4 pounds.
What
modifications would you make to Greg’s treatment plan?
Continuing Care: Four
weeks later, Greg is symptom-free. He is sleeping in his bed and feeling more
rested.
His
treatment plan at this time is as follows…?