Gastroenterology Masterclass
Bill
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Bill is a 42 year old advertising executive who attends because of increasing indigestion.
He is troubled at night with heartburn and has finally come to see you because his wife thought he was having a heart attack at the weekend. The pain lasted about an hour and settled when he got up and took some Rennies.
He sometimes gets pain with eating and has noticed that bending also can produce discomfort.
He uses several packs of Rennies each week.
His job requires quite a lot of travelling and staying in hotels.
He smokes 20 per days, drinks an average of about 20 units per week but has noticed that alcohol may aggravate the problem. He has at least 4 coffees each working day.
Over the last year he has gained about a stone in weight.
On examination there is little apart from some epigastric tenderness.
Questions
a) What do you do next? What advice would you give, would you start treatment and how would you manage him?
b) Are there any other considerations because of his recent more severe episode of heartburn?
c) What is “Test and Treat” and how do you apply this in working practice?
d) Does he need an endoscopy, and if so why, and what information would you want from it?
e) What is Barrett’s oesophagus?
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Study guide by: James Blackstock.
Last updated: 01 October 2006