Mr. M.J. is a 64-year-old patient of Hispanic descent who presents to the clinic today with concerns about epigastric and substernal pain that has gotten progressively worse over the past 3 months. He complains of mild â€œheartburn after eating a large meal for at least 2 years. He has tried over the counter products occasionally with adequate response. Three months ago, he was awakened with severe burning discomfort that extended from his mid-chest to his jaw that lasted 30 minutes before he was able to fall back to sleep. He is now experiencing these attacks about 3 times per week. He has tried avoiding large meals and is now sleeping on two pillows at night to relieve his pain which has improved his pain. The pain now occurs regularly after meals and randomly during the day. He takes antacids with each meal, but the pain still persists. Overall, he considers himself to be very healthy.
Past Medical History
Depression diagnosed 6 months ago
Unknown; was adopted from an orphanage when he was 3 months old; Wife died of breast cancer approximately 8 months ago. They were unable to have children.
Drinks beer occasionally when out with friends
No smoking history
Discussion Questions Part One