[ANSWERED] JJ is a 48-year-old man who presents for evaluation of heartburn. He reports a burning feeling in his chest after eating. It is worse when he eats spicy foods or tomato sauce

JJ is a 48-year-old man who presents for evaluation of heartburn. He reports a burning feeling in his chest after eating.

• What lifestyle modifications do you recommend for JJ?
• What medication do you prescribe for JJ, including how long to use?
• What counseling points about this medication do you give JJ?

Expert Answer and Explanation

Gastroesophageal Reflux Disease

JJ has had recurrent heartburn and has been diagnosed with gastroesophageal reflux disease. While medication can work, JJ needs to make lifestyle modifications as they will alleviate his symptoms. It is also important to counsel him so that he can understand his condition and how he can recover fully.

Lifestyle Modifications

One of the lifestyle modifications that JJ should make is dietary modification as these are the main sources of his issues. Yuan et al. (2019)  note that JJ should avoid spicy food or other food that exacerbates his heartburn. In the future, although he can consume spicy foods it should be limited and he should go for smaller more frequent meals as compared to large ones. Another modification is elevating his bed, by about 6 inches.

This will prevent acid from flowing back into the food pipe during sleeping. It is also necessary for JJ to avoid lying down for at least 2-3 hours after a meal as this will encourage digestion and will reduce the risk of reflux. If JJ is overweight, he should start losing some weight because excessive abdominal fat usually puts pressure on the stomach and worsens the symptoms he is experiencing (Clarrett & Hachem, 2018). If JJ smokes or uses alcohol, it is important to quit the two as this can play a great role in reducing the symptoms he is experiencing.

Medication

The best medication that can work on the symptoms is a proton pump inhibitor mainly used for gastroesophageal reflux disease. According to Kröner et al. (2021), this can be omeprazole, esomeprazole or lansoprazole. A common prescription can be 20 mg of omeprazole daily. It is also notable that the period of consuming the medication should be determined by the care provider. In many instances, proton pump inhibitor therapy is recommended for about 4 to 8 weeks but depends on the patient’s symptoms and their responses to the drugs. If the symptoms cease completely, it is possible to reduce the intake after 4 weeks or cease consumption completely.

Counseling Points

When communicating with JJ about his diagnosis it is important to insist that he takes the medicine as directed which is usually before a meal (Guadagnoli et al., 2022). Additionally, he should adhere to the days given to take the medication as skipping or taking too much will affect their action and might be ineffective in addressing the current symptoms. It is also vital to inform JJ of possible side effects of the PPIs.

This includes headaches and diarrhea. Mentioning the effect of long-term use of the drugs is also critical as they can lead to issues such as vitamin B12 deficiency. This is why it is important to insist on lifestyle modification as it will eliminate the need for the drugs in future.

The healthcare provider must also monitor JJ for improvement and encourage JJ to check his symptoms and if they do not improve he should seek further medical advice. This can include an adjustment of the dose or a complete change of the drugs (Guadagnoli et al., 2022). It is also significant to mention the use of over-the-counter pain relievers.

JJ had mentioned his use of ibuprofen and acetaminophen which can both exacerbate the symptoms. He can instead choose different pain management strategies such as sleeping, resting, or trying to use herbal medicine. It is crucial for JJ to follow the suggestions for lifestyle modifications and to follow the medication regimen. This will successfully manage the symptoms and ensure that he avoids complications associated with chronic reflux.

References

Clarrett, D. M., & Hachem, C. (2018). Gastroesophageal Reflux Disease (GERD). Missouri Medicine, 115(3), 214–218. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140167/#:~:text=The%20primary%20acid%20suppressive%20medications

Guadagnoli, L., Simons, M., McGarva, J., Taft, T. H., & van Tilburg, M. A. (2022). Improving Patient Adherence to Lifestyle Changes for the Management of Gastroesophageal Reflux. Patient Preference and Adherence, Volume 16, 897–909. https://doi.org/10.2147/ppa.s356466

Kröner, P. T., Cortés, P., & Lukens, F. J. (2021). The Medical Management of Gastroesophageal Reflux Disease: A Narrative Review. Journal of Primary Care & Community Health, 12, 215013272110467. https://doi.org/10.1177/21501327211046736

Yuan, L.-Z., Yi, P., Wang, G.-S., Tan, S.-Y., Huang, G.-M., Qi, L.-Z., Jia, Y., & Wang, F. (2019). Lifestyle intervention for gastroesophageal reflux disease: a national multicenter survey of lifestyle factor effects on gastroesophageal reflux disease in China. Therapeutic Advances in Gastroenterology, 12, 175628481987778. https://doi.org/10.1177/1756284819877788

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FAQs

1. Which chemical would you use for the treatment of heartburn a common symptom for acid reflux?
2. Which drug is indicated for heartburn?
3. What is the medical term for heartburn What is the cause of this condition?
4. What medication used to treat patients who have GERD provides the fastest relief of heartburn symptoms?