Drug Prescription
For the patient’s treatment, the author would prescribe esomeprazole, taken daily via the oral route in full 40mg dosages, for four weeks. Zhang et al. (2017) find that this medication in the suggested dosage is the most effective of a number of proton pump inhibitors and histamine-2-receptor antagonists. Antacids are also an option for treating mild cases of gastroesophageal reflux disease (GERD), but the patient’s condition is too severe to resort to them. The severity of the patient’s state is also the reason for the four-week treatment period, as this length is recommended by Farthing and Ballinger (2019). The medication will be distributed orally via capsules, as this is the typical route of its administration, and the patient is capable of swallowing, which precludes the use of a nasogastric tube. No other drugs will be prescribed, as GERD therapy is typically limited to the usage of this medication alone.
Monitoring and Efficacy Evaluation
The monitoring measure employed for the patient will be esophageal pH-impedance monitoring. It is standard practice in the management of GERD, used to evaluate the severity of the condition based on the acid that comes up to the esophagus. Patel et al. (2015) recommend phenotyping the severity of the symptoms and the disease as a whole based on the strength of reflux evidence. Treatment should continue as usual in the case that the patient’s symptoms start declining over time, as this would demonstrate the effectiveness of the treatment. However, in the case that no change is observed, Farthing and Ballinger (2019) recommend performing upper gastrointestinal endoscopy before determining the next course of action. If symptoms start manifesting more heavily than before, the same consideration applies, and the usage of higher dosages of the drug should be considered.
Long-Term Treatment
Long-term treatment should begin after the disappearance of the symptoms and can vary substantially depending on the outcomes of the initial therapy. Farthing and Ballinger (2019) recommend continuing drug therapy in the case that the patient’s GERD is severe or if there are frequent recurrences, both of which may apply to the person in the case study. Due to the nature of GERD monitoring, regular returns to the clinic are likely unnecessary, as esophageal pH-impedance monitoring takes too long, often taking place 24 hours a day. Hence, the patient should self-monitor his symptoms, noting the recurrence of episodes and referring to medical professionals should incidents resume. Regular conversations on the phone regarding the matter will likely be adequate for confirming the patient’s state.
The risks of the condition can be mitigated in the long term by lifestyle changes, about which the patient should be educated. Park et al. (2017) find a reduction in the severity of GERD symptoms in patients with obesity once they lose weight, and the change is recommended for the situation. Abandoning smoking and lowering the fat content in the person’s diet are also two changes that they should make, as they can affect the esophagus and stomach, respectively, contributing to GERD incidents. With regard to episodes when the patient is lying down, they should be educated to arrange their bed in a manner that elevates the head, protecting the esophagus from reflux via gravity. The patient should also try not to lie down for some time after eating to avoid combining the two contributing factors. Through the combination of all these changes, the severity of the condition can be mitigated substantially.
References
Farthing, M. J. G., & Ballinger, A. B. (Eds.). (2019). Drug therapy for gastrointestinal disease. CRC Press.
Park, S. K., Lee, T., Yang, H. J., Park, J. H., Sohn, C. I., Ryu, S., & Park, D. I. (2017). Weight loss and waist reduction is associated with improvement in gastroesophageal disease reflux symptoms: A longitudinal study of 15 295 subjects undergoing health checkups.Neurogastroenterology & Motility, 29(5). Web.
Patel, A., Sayuk, G. S., Kushnir, V. M., Chan, W. W., & Gyawali, C. P. (2016). GERD phenotypes from pH‐impedance monitoring predict symptomatic outcomes on prospective evaluation. Neurogastroenterology & Motility, 28(4), 513-521. Web.
Zhang, C., Kwong, J. S., Yuan, R. X., Chen, H., Xu, C., Wang, Y. P., Yang, G. L., Yan, J. Z., Peng, L., Zeng, X. T., Weng, H., Luo, J., & Niu, Y. M. (2017). Effectiveness and tolerability of different recommended doses of PPIs and H 2 RAs in GERD: Network meta-analysis and GRADE system.Scientific Reports, 7(1). Web.