Discussion #2

Charlie Berger, a 58-year-old obese man, comes to a nurse practitioner because he has difficulty swallowing, heartburn, and occasional regurgitation. Answering his nurse practitioner’s questions, Mr. Berger says that his symptoms worsen when he drinks coffee or alcohol.
Endoscopy reveals inflammation in his lower esophagus and poor closure of the lower esophageal sphincter. There is no evidence of esophageal narrowing or movement of the proximal stomach into the thorax.
The nurse practitioner diagnoses gastroesophageal reflux disease (GERD) and tells Mr. Berger to do the following:

Take proton-pump inhibitor drugs to reduce gastric acid.
Elevate the head of his bed.
Avoid eating large meals, especially near bedtime.
Enter a weight-loss program.
Reduce his use of caffeine and alcohol.

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Answer the following questions about Mr. Berger and gastroesophageal reflux disease.
1. Why did his nurse practitioner tell Mr. Berger to elevate the head of his bed?
2. Why did his nurse practitioner suggest that Mr. Berger avoid eating large meals, especially near bedtime? 
3. Why did his nurse practitioner check to see if Mr. Berger had movement of the proximal stomach into the thorax?
4. Are Mr. Berger’s symptoms of dysphagia, heartburn, and regurgitation specific to GERD?
5. In addition to discomfort, what is a danger of untreated GERD?
6. What is the mechanism by which obesity contributes to GERD?

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