List differential diagnosis that would help confirm GERD while ruling out other diagnosis. Which medication is the best medication for treatment of GERD and why? What labs or other diagnostic tests that are used to confirm GERD? Your response should be at least 350 words.

1. Discussion question

Based on the patient’s presentation and positive Helicobacter pylori test, the most likely diagnosis is peptic ulcer disease. Peptic ulcer disease is treated first with proton pump inhibitors (PPIs), such as pantoprazole or omeprazole. Therefore, I would initially prescribe a PPI, such as omeprazole, for 4 to 8 weeks to help heal the ulcer and relieve the patient’s symptoms.

Side effects of the PPI such as diarrhea or abdominal pain or nausea may occur. Antibiotics and sucralfate can be prescribed for these conditions. If the patient is experiencing anxiety or depression due to their treatment or medical condition, they might be referred to a mental healthcare professional for treatment and further evaluation.

If the patient has been diagnosed with gastroesophageal acid reflux disease (GERD), the treatment plan would follow the same, except that PPIs are the first line. In addition to medications, lifestyle changes such as eliminating trigger foods, weight loss and elevating one’s head may be advised.

Second Discussion Question

GERD refers to a common condition where gastric contents reflux into the esophagus. This can lead to heartburn, regurgitation or dysphagia. Even though GERD can be mimicked by other conditions, it’s important to take into account these different diagnoses in the evaluation of patients who have GERD suspicions.

To confirm GERD, and exclude other conditions from consideration, differential diagnosis may include:

  1. Esophagitis is an inflammation of the esophagus due to infections, medications (NSAIDs or bisphosphonates) and other factors.
  2. Hiatal Hernia (or hiatal protrusion): The condition in which the stomach’s upper portion extends past the diaphragm to the chest.
  3. Helicobacter pylori or NSAIDs can cause ulcers in the stomach and duodenum.
  4. Eosinophilic Esophagitis is a chronic, immune-mediated condition that causes inflammation and tissue damage to the esophagus.
  5. Gastroparesis is a condition in which the stomach doesn’t empty correctly, which can lead to nausea, vomiting and reflux.

A PPI is the best treatment for GERD. It can be used to treat omeprazole (esomeprazole), lansoprazole or pantoprazole. The stomach produces less acid, which reduces symptoms and helps heal the esophagus. With few side effects, PPIs can be very effective.

To confirm GERD, diagnostic tests may include:

  1. Monitoring the pH of the Esophagus: This test measures acid levels over 24 hours.
  2. Upper endoscopy is a procedure using a flexible, thin tube and a camera to inspect the stomach and esophagus.
  3. After consuming a contrast substance, barium swallow is a test using X-rays that allows for visualization of the stomach and esophagus.
  4. Esophageal manometry (Esophageal manometry): This test measures the pressure inside the stomach and determines the strength and coordination muscle contractions.

It is crucial to perform a detailed evaluation, differential diagnosis and confirm GERD. PPIs, which are highly effective and with very few side effects, are the best treatment option for GERD.

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