Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests

Full Answer Section

    . Why did the physician recommend 6 weeks of medical management? Medical management for acid reflux typically includes proton pump inhibitors (PPIs), such as esomeprazole (Nexium). PPIs work by blocking the production of stomach acid. PPIs can be very effective in relieving acid reflux symptoms. However, they can take some time to work. It is typically recommended that patients take PPIs for at least 6 weeks before determining whether the medication is effective. In addition to PPIs, there are a number of lifestyle changes that can also help to relieve acid reflux symptoms. These include:

• Avoiding tobacco and caffeine
• Eating small, frequent meals
• Avoiding foods that trigger acid reflux symptoms, such as spicy foods, fatty foods, and citrus fruits
• Elevating the head of the bed at night

If medical management is not effective, surgery may be an option. Additional information on acid reflux Acid reflux is a common condition in which stomach acid backs up into the esophagus. The esophagus is the tube that connects the throat to the stomach. The symptoms of acid reflux can vary from mild to severe. Some common symptoms include:

• Heartburn
• Regurgitation of sour material into the mouth
• Coughing, especially at night
• Wheezing
• Hoarseness
• Difficulty swallowing
• Chest pain

Acid reflux can be caused by a number of factors, including:

• Hiatal hernia: A hiatal hernia is a condition in which the upper part of the stomach pushes through the diaphragm and into the chest.
• Weak lower esophageal sphincter (LES): The LES is a muscle that acts as a valve between the esophagus and the stomach. When the LES is weak, stomach acid can leak back into the esophagus.
• Delayed gastric emptying: Delayed gastric emptying is a condition in which food takes longer than usual to move from the stomach into the small intestine. This can cause pressure to build up in the stomach, which can lead to acid reflux.
• Certain foods and drinks: Certain foods and drinks, such as spicy foods, fatty foods, citrus fruits, chocolate, coffee, and alcohol, can trigger acid reflux symptoms.
• Pregnancy: Pregnancy can cause acid reflux due to the increased pressure on the stomach from the growing baby.

Acid reflux can be treated with medication, lifestyle changes, or surgery. Medication options include PPIs, H2 blockers, and antacids. H2 blockers and antacids can relieve acid reflux symptoms quickly, but they do not last as long as PPIs. PPIs are more effective for long-term treatment of acid reflux. Lifestyle changes that can help to relieve acid reflux symptoms include:

• Avoiding tobacco and caffeine
• Eating small, frequent meals
• Avoiding foods that trigger acid reflux symptoms, such as spicy foods, fatty foods, and citrus fruits
• Elevating the head of the bed at night

Surgery is an option for patients with severe acid reflux that does not respond to medication or lifestyle changes. Surgery to repair a hiatal hernia or to strengthen the LES can help to relieve acid reflux symptoms.  

Sample Solution

   

Critical Thinking Questions

1. Why would the patient be instructed to avoid tobacco and caffeine?

Tobacco and caffeine can relax the lower esophageal sphincter (LES), which can make acid reflux worse.

The LES is a muscle that acts as a valve between the esophagus and the stomach. When the LES is working properly, it prevents stomach acid from backing up into the esophagus. However, when the LES is relaxed, stomach acid can leak back into the esophagus, causing heartburn and other symptoms of acid reflux.

Tobacco and caffeine can both relax the LES. Tobacco contains nicotine, which is a stimulant that can relax muscles throughout the body. Caffeine is a stimulant that can also relax the LES.