Gastrointestinal Case Study
CF is a 48-year-old man who presents for evaluation of heartburn. He denies current tobacco use but has a history of one ppd for 15 years. He consumes a glass of wine nightly, more on the weekends. He has a sedentary job.
He reports a burning feeling in his chest after eating. It is worse when he eats spicy foods or tomato sauce. He is sometimes awakened at night with these symptoms. He has tried over-the-counter antacids and histamine H2 receptor antagonists (H2RAs) with partial relief. He is on no regular medications. His examination today is normal. An upper gastrointestinal (GI) X-ray series reveals gastroesophageal reflux.
- What lifestyle modifications do you recommend for CF?
- Describe a rational drug choice for this patient. Be specific regarding what factors you would consider. Include pharmacokinetic and dynamic considerations for the pharmacological choices made. Also consider interactions and side effects.
- What counseling points about this medication do you give CF?
POST # 1 AYME
The case of CF (48 y/o man) represents a positive diagnosis of Gastroesophageal Reflux Disease (GERD). In his case, it seems that the GERD has been persistent and there are various aggravators of the condition that feature. For instance, his history of smoking might be blamed for the aggravation of the condition in its early stages. Nevertheless, various factors within his current lifestyle have been associated with the exacerbation of the GERD. These include the use of alcohol, eating spicy foods, and having a sedentary lifestyle (Sethi & Richter, 2017). The management of GERD requires the use of both lifestyle modifications and medications. In this regard, this paper delves deeper into CF’s treatment in light of this diagnosis.
- What lifestyle modifications do you recommend for CF?
Lifestyle aspects such as a sedentary lifestyle increase the risk of overweight and obesity which are among the risk factors of GERD. Besides, eating spicy foods as well as alcohol use is part of lifestyle factors that exacerbate acid reflux. Therefore, the lifestyle recommendations for this patient include alcohol cessation, avoiding spicy foods, and increased uptake of physical activities, weight management as well as avoiding other foods or drinks that trigger the acid reflux. Acidic beverages and drinks such as coffee worsen the GERD, therefore, accentuating the need to advise the patient on the right beverages or drinks that do not worsen the reflux. These lifestyle modifications have been associated with the suppression of the acid reflux as well as subduing some of the pathophysiological mechanisms linked to the progression or exacerbation of the condition (Sethi & Richter, 2017). Even though the patient denies any current smoking, it is important to emphasize the necessity of desisting from tobacco smoking. Finally, lifestyle recommendations should insist on the need to take small amounts of foods as well as enhancing self-stress-management and coping skills since stress can worsen the condition.
- Describe a rational drug choice for this patient. Be specific regarding what factors you would consider. Include pharmacokinetic and dynamic considerations for the pharmacological choices made. Also, consider interactions and side effects.
This case represents a scenario of persistent GERD that has resisted the common OTC medications. In this regard, it is important to up-scale his treatment to include the use of proton-pump-inhibitors and Baclofen. Proton pump inhibitors suppress the parietal production of acids that worsen acid reflux. Baclofen, on the other hand, helps in reducing the frequency of the gastroesophageal sphincter. These medications are largely tolerated and do not cause serious side-effects and if at all, the side-effects are always mild and tolerable. Nevertheless, as a major consideration, it is important to acknowledge that prolonged or long-term use of proton pump inhibitors has been associated with kidney problems (Sethi & Richter, 2017). In this regard, it is important to monitor the patient’s progress throughout the treatment to offer interventional measures in the event of these adverse effects.
- What counseling points about this medication do you give CF?
The use of proton pump inhibitors together with other medications can lead to undesired drug interactions. Notably, this effect of proton pump inhibitors of the gut’s acidity levels can affect the efficacy of medications such as protease inhibitors, isoniazids, and ketoconazole (Nehra, Alexander, Loftus & Nehra, 2018). Therefore, medical counseling for this patient should include the need to only use these medications following medical advice or only take them at the end of the proton pump inhibitors dosage interval. Other counseling should focus on the importance of medication adherence as well as reporting any abnormal effects.
References
Nehra, A. K., Alexander, J. A., Loftus, C. G., & Nehra, V. (2018, February). Proton pump inhibitors: review of emerging concerns. In Mayo Clinic Proceedings (Vol. 93, No. 2, pp. 240-246). Elsevier.
Sethi, S., & Richter, J. E. (2017). Diet and gastroesophageal reflux disease: role in pathogenesis and management. Current opinion in gastroenterology, 33(2), 107-111.
