Charlie Berger, a 58-year-old obese man, comes to his primary care provider because he has
difficulty swallowing, has heartburn, and experiences occasional regurgitation. Answering his
provider’s questions, Mr. Berger
...
Charlie Berger, a 58-year-old obese man, comes to his primary care provider because he has
difficulty swallowing, has heartburn, and experiences occasional regurgitation. Answering his
provider’s questions, Mr. Berger says that his symptoms worsen when he drinks coffee or
alcohol.
Today, endoscopy reveals inflammation in his lower esophagus and poor closure of the lower
esophageal sphincter. There is no evidence of esophageal narrowing or movement of the
proximal stomach into the thorax.
The provider diagnoses gastroesophageal reflux disease (GERD).
1. What lifestyle modifications should you teach Mr. Berger in order to prevent or reduce
GERD symptoms?
Avoiding tobacco
Avoiding aggravating food (citrus fruits, tomatoes, onions, spicy foods) and
aggravating drinks (carbonated beverages).
Weight loss
Avoiding alcohol
Avoiding late night meals
Sleep with head of bed elevated (Burchum & Rosenthal, 2016, p.964).
2. Why did his provider check to see if Mr. Berger had movement of the proximal stomach
into the thorax?
Movement of the proximal stomach into the thorax is a hiatal hernia. Patients with hiatal
hernia are predisposed to GERD (Burchum & Rosenthal, 2016, p.725).
3. What is the mechanism by which obesity contributes to GERD?
Pressure of excess belly fat on the stomach increases the risk of GERD (Burchum &
Rosenthal, 2016, p.725).
4. What is metaplasia? Why does it occur?
Transformation/replacement of one differential cell type with another. Metaplasia
results from continuous injury (Copstead & Banasik, 2013, p.63-64).
5. Why might reducing his intake of caffeine and alcohol decrease Mr. Berger's symptoms?
Caffeine and alcohol reduce the strength needed for closing of the lower esophageal
sphincter (Copstead & Banasik, 2013, p.724).
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