Question

TS is 67 years old with a long history of knee osteoarthritis for which he self-medicates regularly with over-the-counter (OTC) naproxen. He is in the clinic today complaining of a swallowing difficulty that has progressively worsened over the past several months. He has otherwise been healthy and has not seen a doctor in many years.

TS denies significant past medical history. A review of systems is negative except for arthritic symptoms and swallowing difficulty. He denies noticing blood in his stool and vomiting blood. He denies history of gastroesophageal reflux disease (GERD) and ulcer.

He does not drink alcohol, although he drank heavily many years ago. He does not smoke. TS describes the dysphagia this way: “Food gets stuck in my throat, and I can’t get it down.” The feeling occurs only after he has ingested solid food; liquids are not a problem. There is burning chest pain associated with meals.

He is scheduled for an upper gastrointestinal endoscopy.

1. What is the likely cause of his dysphagia?
2. What advice should TS be given regarding his OTC medication at this time?
3. What are the usual signs and symptoms of GERD? How will it be managed?

Answer 1

1. Naproxen is an NSAID drugs, and it induces the local irritation in the gastrointestinal tract. Similarly it also induces the local irritation, lesions and ulcerations in the esophagus on prolong use. The cause of dysphagia is self-medication of naproxen. Treatment with naproxen for long time causes the difficulty in breathing and swallowing. The long term intake of naproxen caused injury to the esophagus by local irritation effect. This led to the dysphagia and difficulty in the swallowing.

2. The patient may be advised regarding this medication are:

• Do not take medicine without consultation of physician or healthcare professionals.
• Take this medicine with plenty of water.
• Do not overdose the medicine.
• Do not smoke or drink.
• Elevate the head side of your bed.
• Do not lie on bed immediately after meal.
• Report to health care professionals for any symptoms like GERD, GI irritation, any bleeding, rashes, itching etc.

3. Sign and symptoms of GERD.

GERD is (Gastroesophageal Reflux Disorder) is a digestive disorder, which is caused due to the reflux of the stomach acidic content in the esophagus. The common signs and symptoms of GERD are;

• Burning sensation in chest i.e. heartburn.
• Difficulty in breathing and swallowing
• Regurgitation of food.
• Sensation of lump in the throat

GERD can be managed by medication as well as life style modification like avoid heavy meals, avoid acidic foods, alcohol, chocolates, onion etc. Decrease dietary fat intake, lose weight, avoid smoking, avoid medication that potentiate GERD symptoms like NSAIDs, sedatives, calcium channel blockers, beta blockers etc.

GERD can be relieved from using antacids, H2 receptor antagosnists, proton pump inhibitors like omeprazole. GERD can be mannaged by surgical procedure also that helps to prevent the reflux of the stomach content to the esophageal sphincter.