A 58-year-old man has 3 months of heartburn and sour regurgitation. He reports progressive dysphagia to solids and 12-lb unintentional weight loss.

Question

A 58-year-old man has 3 months of heartburn and sour regurgitation. He reports progressive dysphagia to solids and 12-lb unintentional weight loss. Antacids provide partial relief. Examination is unremarkable. Which of the following is the most appropriate next step in management?

Accepted Answer

Arrange upper endoscopy

Answer

Begin empiric proton pump inhibitor therapy alone

Answer

Perform urea breath testing as the next test

Answer

Order pH monitoring first

Answer

Reassure and review dietary triggers

GERD alarm features — USMLE Step 3 MCQ

A 58-year-old man has 3 months of heartburn and sour regurgitation. He reports progressive dysphagia to solids and 12-lb unintentional weight loss. Antacids provide partial relief. Examination is unremarkable. Which of the following is the most appropriate next step in management?