A 50-year-old housewife consulted her family practitioner
with the request for something to relieve her severe
heartburn. When the doctor took a detailed history, this
revealed that the patient had been experiencing a burning
pain for several years, which she localized to about the
middle of the body of the sternum. There was no radiation
of the pain. She had been self-medicating, with some
success until recently, using a whole variety of proprietary
indigestion and antacid tablets and medicines. The pain
would come on shortly after her meals, especially her
evening dinner, the main meal of the day. She also had her
sleep disturbed by the pain and had noticed that this was
less likely to happen if she slept propped up with pillows.
She also found that the pain might come on if she stooped
down, for instance to pick something up from the floor.
Occasionally at night or on stooping she had noticed
regurgitation of bitter-tasting fluid into her mouth, and this
she had found to be particularly unpleasant, but she had
never actually vomited.
On direct questioning, she had never noticed the food
sticking in the chest on swallowing, i.e. there was no
evidence of actual dysphagia. Apart from these symptoms
she was well, her appetite good and her bowels acted
normally. She had had three children and had gained a lot
of weight after the third pregnancy and was now quite
obese. Functional enquiry was otherwise normal.
Apart from her obesity and moderate hypertension (blood
pressure 160/110), clinical examination was normal.

https://twitter.com/DrATEFAHMED/status/1644061633625444366?s=20
A 50-year-old housewife consulted her family practitioner with the request for something to relieve her severe heartburn. When the doctor took a detailed history, this revealed that the patient had been experiencing a burning pain for several years, which she localized to about the middle of the body of the sternum. There was no radiation of the pain. She had been self-medicating, with some success until recently, using a whole variety of proprietary indigestion and antacid tablets and medicines. The pain would come on shortly after her meals, especially her evening dinner, the main meal of the day. She also had her sleep disturbed by the pain and had noticed that this was less likely to happen if she slept propped up with pillows. She also found that the pain might come on if she stooped down, for instance to pick something up from the floor. Occasionally at night or on stooping she had noticed regurgitation of bitter-tasting fluid into her mouth, and this she had found to be particularly unpleasant, but she had never actually vomited. On direct questioning, she had never noticed the food sticking in the chest on swallowing, i.e. there was no evidence of actual dysphagia. Apart from these symptoms she was well, her appetite good and her bowels acted normally. She had had three children and had gained a lot of weight after the third pregnancy and was now quite obese. Functional enquiry was otherwise normal. Apart from her obesity and moderate hypertension (blood pressure 160/110), clinical examination was normal. https://twitter.com/DrATEFAHMED/status/1644061633625444366?s=20
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