The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
For 2 months, a 63-year-old woman had persistent acid reflux that was not relieved with over-the-counter antacids. She presented to her primary care physician, who referred her for an esophagogastroduodenoscopy (EGD). The EGD revealed gastritis. Figure 1 shows a light micrograph with hematoxylin and eosin (H&E) staining that depicts similar gastritis.
A proton pump inhibitor (PPI) was prescribed but the patient's symptoms persisted. She also began to have intermittent epigastric pain and early satiety and, as a result, experienced a 15-lb weight loss over approximately 3 months. She does not report a fever or chills, chest pain, or shortness of breath. She has one or two formed bowel movements a day, with no noticeable blood in the stool. She reports intermittent nausea but no vomiting.
Her medical history is significant for a diagnosis of infiltrating lobular carcinoma (ILC) of the breast in 2020. She underwent bilateral mastectomy, which revealed a stage IIIA ILC of the right breast that was hormone receptor positive and human epidermal growth factor receptor 2 negative (HR+/HER2-). She completed staging with CT of the chest, abdomen, and pelvis and a bone scan, which were negative for evidence of distant metastatic disease. She completed adjuvant chemotherapy and adjuvant radiation therapy and started endocrine therapy, which she has continued to receive up until her presentation.
The patient has no family history of cancer. The results of germline genetic testing, performed when she received a diagnosis of breast cancer, were negative.
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Cite this: Avan Armaghani. Acid Reflux Despite PPI Use in a Woman Losing Weight - Medscape - Apr 03, 2023.