Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 48-year-old man is evaluated for a 4-week history of heartburn that awakens him at night. The symptoms occur about three times per week. He has been taking over-the-counter antacids with incomplete relief. Food triggers include coffee and spicy foods. He has not had unintentional weight loss or difficulty swallowing.
Physical examination and laboratory studies are normal.
Which of the following is the most appropriate next step in management?
A. Ambulatory esophageal pH monitoring
B. Esophageal manometry
C. Trial of a proton pump inhibitor
D. Upper endoscopy
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