03-21-2016, 08:36 PM
A 37-year-old woman comes to the office because of a "burning sensation" in the chest for the past 3 months. The "burning" typically begins in the "upper stomach and travels up to the neck." The symptoms worsen when she lies down to go to sleep. She is a chef at a local American restaurant, has 3 children, and has been married for 12 years. She "tries" to eat a healthy diet, but it is difficult because she is around food all day and night. She has no chronic medical conditions, takes no medications, and does not drink alcohol or caffeine-containing beverages. She recently quit smoking. Her temperature is 37.0 C (98.6 F), blood pressure is 120/80 mm Hg, pulse is 65/min, and respirations are 14/min. Physical examination is unremarkable. An electrocardiogram is unremarkable. A complete blood count and metabolic profile are normal. Serologic testing for H. pylori is negative. The most appropriate next step is to
A. order ambulatory esophageal pH testing
B. order an upper gastrointestinal barium radiograph
C. recommend elevation of the head of bed and avoidance of food before bedtime
D. schedule an upper endoscopy
E. schedule esophageal manometry
A. order ambulatory esophageal pH testing
B. order an upper gastrointestinal barium radiograph
C. recommend elevation of the head of bed and avoidance of food before bedtime
D. schedule an upper endoscopy
E. schedule esophageal manometry