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Background: Siobhan Smith, a 45-year-old instructor, has come to the clinic to discuss frequent “heartburn and vomiting” for the past 3 months. She has no issues with swallowing, food getting stuck, or respiratory issues. There is no abdominal pain. She has tried over-the counter antacids with only a little relief. Desired Outcomes: 1. Determine if Siobhan’s sensations of “heartburn” are, in fact, gastroesophageal reflux disease (GERD). 2. Educate Siobhan on the potential causes of GERD. 3. Identify appropriate recommendations based on the findings of a GI endoscopy. Findings: Siobhan’s upper GI endoscopy found inflammation within the esophageal and pharyngeal mucosa. No abnormal findings were found within the stomach of intestines. A further esophageal pH test determined that excess acid was built up within the esophagus. Questions: 1. What is the anatomical structure that malfunctions in individuals with GERD? 2. Explain how stomach acid can affect mucus membranes that are not adequately protected. 3. What are some of the potential reasons that Siobhan could be experiencing GERD? 4. What are some of the lifestyle changes that Siobhan may take that could reduce the severity of GERD symptoms. 5. Siobhan mentioned that she had been taking antacids, but they were not effective in decreasing the symptoms. Why might the antacids not have been effective? How might being prescribed an H2 antagonist or PPI result in better health outcomes?

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