Mike is a 46-year-old who presents with a complaint of "heartburn" for 3 months. He describes the pain as burning and it is located in the epigastric area. The pain improves after he takes an antacid or drinks milk. He has been taking either over-the-counter (OTC) famotidine or ranitidine off and on for the past 2 months and he still has recurring epigastric pain. He has lost 6 lb since his last visit.
ASSESSMENT
His examination is unremarkable. His blood pressure (BP) is 118/72. Laboratory values are normal complete blood count (CBC) and a positive serum Helicobacter pylori test.
What would you prescribe initially?
How long would you prescribe these medications?
What other possible meds could you prescribe to assist with the side effects from the medications prescribed?
How would the treatment vary if the patient has GERD instead?
List differential diagnosis that would help confirm GERD while ruling out other diagnosis. Which medication is the best medication for treatment of GERD and why? What labs or other diagnostic tests that are used to confirm GERD?