Question

A 45 year old male presents with intermittent chest pain for the past month. He describes burning, retrosternal pain that usually occurs after eating or while lying down or bending over. He also notes that he has been hoarse lately, especially upon awakening in the morning. Past medical history includes a father and grandfather who died of coronary artery disease in their 60s. In the office, the patient is comfortable, and physical examination is entirely unremarkable. Which of the following is the most appropriate initial step in the management of this patient?

A. Metoclopramide
B. Ranitidine
C. Lansoprazole
D. Lifestyle modification and smoking cessation
E. Upper endoscopy

Answer 1

The patient's described symptoms and habbits are indicative of GERD; thus, the first step in management should be lifestyle modifications and smoking cessation before considering pharmacological interventions.

Step-by-step explanation:

The patient's symptoms, including burning, retrosternal pain after eating, lying down, or bending over, and morning hoarseness, suggest a likely diagnosis of gastroesophageal reflux disease (GERD). Considering the benign nature of the examination, the most appropriate initial step in management would likely involve non-pharmacological lifestyle modification and smoking cessation if applicable. Such modifications may include eating smaller meals, avoiding foods that trigger reflux, elevating the head of the bed, and not lying down immediately after eating. Pharmacologic intervention could be considered if lifestyle modifications are insufficient.