Gerd Case Study

Question: RJ has GERD and is currently taking omeprazole 20 mg daily. He is overweight, sedentary, and smokes about 1 pack per day. He states that he does not feel he needs to make lifestyle modifications because he is on medications for his GERD. What would you like to tell him?

Reflection:

I would tell RJ that taking 20 mg of omeprazole daily for his gastroesophageal reflux disease is not enough. According to medical resource website UpToDate, many patients with gastroesophageal reflux disease (up to 40%) do not respond to standard daily doses of proton pump inhibitors like omeprazole and continue to have debilitating symptoms such as acid indigestion and heartburn. However, even if he is experiencing some relief with the daily dose of omeprazole, there is more he can do to treat his GERD symptoms. For example, weight loss has been proved to reduce symptoms. Any excess body fat increases your risk for having heartburn. This is likely because extra fat around the abdomen causes increased pressure on your stomach, causing fluid to rise up. Additionally, dietary modifications can decrease GERD symptoms. RJ should begin cutting out fatty foods, caffeine, chocolate, spicy foods, food with a high fat content, and carbonated beverages. I would also tell RJ that he needs to stop smoking as smoking diminishes salivation. Even 1 cigarette a day is too much. Increased saliva is important to someone with gastroesophageal reflux disease because it neutralizes stomach acid and increases the rate of esophageal acid clearance. Another thing that RJ needs to know is that being sedentary is not helping his symptoms either. Strong abdominal muscles strengthen the antireflux barrier of the lower esophageal sphincter. If RJ gets off the couch, starts exercising more, and works on strengthening his core, his reflux will decrease. In fact, if RJ follows all the suggestions I have given him, he should not need to take the omeprazole.