Question

TS is 67 years old, with a long history of knee osteoarthritis for which he self-medicates regularly with over-the-counter (OTC) naproxen. He is in the clinic today complaining of a swallowing difficulty that has progressively worsened over the past several months. He has otherwise been healthy and has not seen a doctor in many years. He denies significant past medical history. A review of systems is negative except for arthritic symptoms and swallowing difficulty. He denies noticing blood in his stool or vomiting blood. He denies a history of gastroesophageal reflux disease (GERD) or ulcer. He does not drink alcohol, although he drank heavily many years ago. He does not smoke. The dysphagia he describes thus: "Food gets stuck in my throat and I can't get it down." The feeling occurs only after he has ingested solid food; liquids are not a problem. There is burning chest pain associated with meals. He is scheduled for an upper GI endoscopy. Answer these questions based on the chapter 36 content provided: 1. What is the likely cause of the dysphagia? 2. What advice should he be given regarding his OTC medication at this time? 3. What are the usual signs and symptoms of GERD? How will it be managed?

          TS is 67 years old, with a long history of knee osteoarthritis for which he self-medicates regularly with over-the-counter (OTC) naproxen. He is in the clinic today complaining of a swallowing difficulty that has progressively worsened over the past several months. He has otherwise been healthy and has not seen a doctor in many years. He denies significant past medical history. A review of systems is negative except for arthritic symptoms and swallowing difficulty. He denies noticing blood in his stool or vomiting blood. He denies a history of gastroesophageal reflux disease (GERD) or ulcer. He does not drink alcohol, although he drank heavily many years ago. He does not smoke. The dysphagia he describes thus: "Food gets stuck in my throat and I can't get it down." The feeling occurs only after he has ingested solid food; liquids are not a problem. There is burning chest pain associated with meals. He is scheduled for an upper GI endoscopy. Answer these questions based on the chapter 36 content provided: 1. What is the likely cause of the dysphagia? 2. What advice should he be given regarding his OTC medication at this time? 3. What are the usual signs and symptoms of GERD? How will it be managed?

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