A 53-year-old woman presents to her primary care practitioner because of generalized weakness, light-headedness, and fatigue for the past month. She also describes dysphagia, heartburn, and occasional regurgition after eating or lying down. She often takes over-the-counter antacids for heartburn, and recently she was told she was anemic, so she started taking an iron supplement. She has no relevant family history. A review of systems is notable for menopause 2 years ago and no vaginal bleeding since. She had a screening colonoscopy at age 50, which was normal. Her physical examination is unremarkable, except for pale skin and a pulse of 110/min. Which of the following is the next best step for this patient?
Correct answer: Upper endoscopy
General Feedback
This patient has several symptoms of gastroesophageal reflux disease (GERD), a condition defined as having bothersome symptoms or esophageal mucosal damage due to the pathologic reflux of stomach contents into the esophagus. The two classic symptoms of GERD are heartburn (pyrosis) and regurgitation. Heartburn is a burning sensation in the retrosternal area, which most commonly occurs after eating. Regurgitation is the sensation of bringing up acidic gastric contents and some small amounts of undigested food into the mouth or hypopharynx. Other symptoms of GERD include dysphagia (difficulty swallowing), odynophagia (pain when swallowing), chest pain, hypersalivation, chronic cough, and hoarseness.
An upper endoscopy (or esophagogastroduodenoscopy [EGD]) is indicated if the patient has so-called “alarm features” that are suggestive of a malignancy or a fibrotic esophageal stricture. An EGD is also indicated if there are risk factors for Barrett esophagus. Alarm features in patients with GERD include iron deficiency anemia, dysphagia, odynophagia, persistent vomiting, unexplained weight loss, and evidence of gastrointestinal bleeding. This patient has the 2 alarm features of iron deficiency anemia and dysphagia.
A 53-year-old woman presents to her primary care practitioner because of generalized weakness, light-headedness, and fatigue for the past month. She also describes dysphagia, heartburn, and occasional regurgition after eating or lying down. She often takes over-the-counter antacids for heartburn, and recently she was told she was anemic, so she started taking an iron supplement. She has no relevant family history. A review of systems is notable for menopause 2 years ago and no vaginal bleeding since. She had a screening colonoscopy at age 50, which was normal. Her physical examination is unremarkable, except for pale skin and a pulse of 110/min. Which of the following is the next best step for this patient?
Correct answer: Upper endoscopy
General Feedback
This patient has several symptoms of gastroesophageal reflux disease (GERD), a condition defined as having bothersome symptoms or esophageal mucosal damage due to the pathologic reflux of stomach contents into the esophagus. The two classic symptoms of GERD are heartburn (pyrosis) and regurgitation. Heartburn is a burning sensation in the retrosternal area, which most commonly occurs after eating. Regurgitation is the sensation of bringing up acidic gastric contents and some small amounts of undigested food into the mouth or hypopharynx. Other symptoms of GERD include dysphagia (difficulty swallowing), odynophagia (pain when swallowing), chest pain, hypersalivation, chronic cough, and hoarseness.
An upper endoscopy (or esophagogastroduodenoscopy [EGD]) is indicated if the patient has so-called “alarm features” that are suggestive of a malignancy or a fibrotic esophageal stricture. An EGD is also indicated if there are risk factors for Barrett esophagus. Alarm features in patients with GERD include iron deficiency anemia, dysphagia, odynophagia, persistent vomiting, unexplained weight loss, and evidence of gastrointestinal bleeding. This patient has the 2 alarm features of iron deficiency anemia and dysphagia.