MEDizzy - A 26-year-old man complains of heartburn. He also complains

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Acute Complaints

A 26-year-old man complains of heartburn. He also complains of regurgitation, belching, and occasional dry cough. His symptoms are worse when he is lying down. He denies melena, weight loss, or dysphagia. What is the appropriate next step, if you suspect gastroesophageal reflux disease (GERD) in this patient?

ExplanationReflux can be appropriately diagnosed by medical history and by evaluating the response to treatment after 4 to 8 weeks. Those who respond are likely to have the diagnosis. Upper endoscopy fails to reveal GERD in 36% to 50% of the patients who have been found to have GERD by a pH probe. EGD should be performed if bleeding, weight loss, or dysphagia is present, especially in an elderly patient. The other tests have not been shown to be sensitive or specific enough to replace response to treatment as a diagnostic tool.