Heartburn Case #1

JZ, a 34 yo wf, comes into the pharmacy complaining of frequent heartburn (3 – 4 times per week) of uncertain duration. She has describes the pain as a "burning feeling in the chest" usually following meals. Sometimes she feels almost like she is regurgitating her food but does not vomit. She states the symptoms seem to worsen when she lies down.

She denies any recent weight loss. Ht: 5'8"; Wt: 178 lbs

She has taken antacids (both Tums and Rolaids) in the past and says they give temporary relief but she feels like she is taking them all the time and would like to try something else.

A 24-hour dietary recall reveals the following:

     Breakfast:  2 C. coffee (black), 8 oz. fruit juice, 2 fried eggs, Toast with 1 T butter
     Snack:  Coffee (black), Cinnamon Roll
     Lunch:  Chicken Fried Steak Sandwich w/ Mayo, fries, Salad w/ Creamy Italian dressing (1-2 T),        Coffee (black)
     Snack:  Orange Sherbet, Soda Pop
     Dinner: Chicken Tetrazinni, Buttered green beans w/ bacon, Roll w/ butter, Apple Pie, 16 oz. Beer
     Snack:  12 oz. whole Milk, 1/2 peanut butter sandwich, 2 oz. salted pretzels

1. What is the Diagnosis?

2. What treatments would be appropriate to treat this patient?

3. What would you recommend for this patient?

4. Would you refer this patient to see a physician? If not, when would you refer a patient?