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.

Questions and topics for discussion:

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

?Dysphagia sometimes occurs in patient with osteoarthritis. Because the joints and bone near to throat have pain means, the usually the person will feel for difficulties in swallowing. Here TS is old aged, and chronic osteoarthritis patient also. So this may be the reason for his dysphagia.

?Naproxen not have more side effects like dysphagia or GERD symptoms. Compared to other medicines, he can continue with the same medication. It have side effects also, the benefit is more than with that.

?GERD symptoms are stomach upset, pain, vomiting, acid reflux, dysphagia, blood in stool, feeling if lump in throat, chest pain that worsen on night, bitter taste, nausea, belching,