A 35-year-old woman with heartburn and regurgitation for 6 months is referred for evaluation of chronic GERD symptoms. The patient states that she notes burning in her chest primar... A 35-year-old woman with heartburn and regurgitation for 6 months is referred for evaluation of chronic GERD symptoms. The patient states that she notes burning in her chest primarily after meals and occasionally experiences episodes of chest pain. She denies change in weight or lifestyle. She often consumes dinner 2 hours before going to bed. Her heartburn occurs mainly during the night. Physical examination is normal except for a body mass index (BMI) of 28 kg/m2. A complete blood count and metabolic panel are normal. The patient has been taking omeprazole 20 mg daily. An upper endoscopic examination is performed, and the appearance of distal esophagitis. Which of the following is the best next step? A. Add antacid twice/day B. Ranitidine at bed time C. Advise her to lose weight D. Refer her for Nilsson Fundoplication
Understand the Problem
The question is presenting a clinical case of a 35-year-old woman suffering from chronic GERD symptoms. It details her symptoms, treatment history, and examination findings, and asks for the best next step in her management, suggesting options that may include adding medications, lifestyle changes, or referrals for surgical intervention.
Answer
Increase the dosage of omeprazole to twice daily.
Increase the dosage of omeprazole to twice daily (Options not directly listed)
Answer for screen readers
Increase the dosage of omeprazole to twice daily (Options not directly listed)
More Information
For GERD patients with persistent symptoms on a proton pump inhibitor (PPI) like omeprazole once daily, the typical next step is to increase the PPI dose to twice daily. This approach often helps in managing nighttime symptoms and should be attempted before considering surgical options like fundoplication.
Tips
A common mistake is to immediately refer for surgery or switch to a different medication before optimizing the current treatment regimen.
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