Question of the Week

For February 23, 2021

A 60-year-old man with previously diagnosed hypertension, gastroesophageal reflux disease, and a 25-pack-year history of cigarette smoking presents for evaluation of heartburn. He has been taking omeprazole 20 mg by mouth daily for the past 8 years, which has generally controlled his reflux symptoms, but he is now having heartburn after meals 2 to 3 nights weekly. He reports no nausea, vomiting, or weight loss. He recently underwent cardiac stress testing in the emergency department, which was negative. He has no family history of cancer and had a normal colonoscopy 2 years ago.

On physical examination, he has normal vital signs and is in no acute distress. His oropharyngeal examination is normal, and he has no cervical lymphadenopathy. Heart and lung sounds are normal. His abdomen is soft and nontender, and he has central adiposity.

In addition to increasing the patient’s proton-pump-inhibitor dose, which one of the following tests should be ordered?

Abdominal radiography
Esophagogastroduodenoscopy
Esophageal pH testing
Barium swallow study
CT of the chest, abdomen, and pelvis

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