Mike is a 46-year-old who presents with a complaint of “heartburn” for 3 months. He describes the pain as burning and it is located in the epigastric area. The pain improves after he takes an antacid or drinks milk. He has been taking either over-the-counter (OTC) famotidine or ranitidine off and on for the past 2 months and he still has recurring epigastric pain. He has lost 6 lb since his last visit.
His examination is unremarkable. His blood pressure (BP) is 118/72. Laboratory values are normal complete blood count (CBC) and a positive serum Helicobacter pylori test.
What would you prescribe initially?
How long would you prescribe these medications?
What other possible meds could you prescribe to assist with the side effects from the medications prescribed?
How would the treatment vary if the patient has GERD instead?
In our presented case, the patient who’s a 46-year-old male, has complaints of heartburn that he says has lasted for three months and presents as burning pain around the epigastric area. Generally, epigastric pain denotes discomfort right below the ribs in the upper abdomen area that often occurs alongside other common symptoms of the digestive system. The symptoms may include heartburn (Jewell, 2019). In such a case, the care provider must examine the patient comprehensively to define the best medication for excellent outcomes.
What I Would Initially Prescribe
Initially, I would prescribe proton pump inhibitors like omeprazole, pantoprazole, lansoprazole, rabeprazole, dexlansoprazole and esomeprazole. In this case, as the patient has been taking OTC medication, also known as H-2-receptor antagonists famotidine and ranitidine, and still has experienced a recurring epigastric pain, I would prescribe proton pump inhibitors known as Omeprazole. This particular treatment is used for heartburn, gastrointestinal illness, and acid-based conditions (Katelaris & Bell, 2017). Omeprazole works by blocking the site of acid creation in the parietal cell of the stomach. The parietal cell of the stomach is continually reproducing; thus, there’s inhibition of acid production in the stomach, thus making the medication safe for all clients.
How long I Would Prescribe the Medication
I would prescribe the medication for two weeks or 14 days. Omeprazole usually is taken for two weeks or 14 days. Strictly patients should not take this medicine for over 14 days as it may cause low patient levels of magnesium blood such as body weakness, vitamin B-12 deficiency, unusually fast, irregular heartbeat, insistent muscle spasms, or seizures, rash on cheeks, and nose and joint pain. The medication is taken via mouth one time a day before all meals.
Other Possible Meds I Would Prescribe to Assist with Side Effects from Medication
Other medications I would prescribe to help with side effects are antacids such as calcium carbonate to release heartburn, upset stomach, and acid indigestion (Jung et al., 2021). Chemicals in antacids include alkaline that is the opposite of acids. The reaction between acid and alkaline is known as neutralization. Neutralization makes abdominal contents less damaging.
How the Treatment Would Vary If Patient Instead Has GERD
The treatment might not vary for GERD as heartburn treatment works similarly with GERD by neutralizing or counteracting the stomach’s acid and is turned into alkaline that cuts down heartburn, acid indigestion, sour stomach, and stomach upset. The first-line treatment for GERD is Antacids since it rapidly reduces acid in the stomach that may relieve GERD symptoms (Chapelle et al., 2020). But it might vary through dietary and lifestyle changes. GERD is an enduring and more severe form of acid reflux than heartburn with acid reflux and GERD symptoms. Though it may still vary with GERD treatment, it can be added with the prokinetic agents apart from proton pump inhibitors and antacids. Prokinetic agents such as metoclopramide are medications that improve the motility of the esophagus and enhance the activity of the muscle in the gastrointestinal tract. The medicines are less active than Antacid and PPIs. Usually, this is prescribed together with an acid-suppressing drug.