In a 32-year-old patient with burning epigastric pain and reflux, the most appropriate next step in management is?

In a 32-year-old patient with burning epigastric pain and reflux, the most appropriate next step in management is?

• A. Endoscopy
• B. H. pylori test
• C. Antacids
• D. Proton-pump inhibitor

Answer: (D)

Typical gastroesophageal reflux disease symptoms in a young adult without red flags are best addressed with acid suppression using a proton-pump inhibitor. This class of medication directly reduces gastric acid production, which decreases irritation of the esophagus, promotes healing if esophagitis is present, and provides more reliable and lasting symptom relief than antacids. Starting a PPI gives a clear test of whether acid reflux is driving the symptoms, with a plan to reassess after a course of therapy. Endoscopy is reserved for alarm features (such as weight loss, persistent vomiting, GI bleeding, trouble swallowing) or for patients with symptoms that do not respond to initial therapy. H. pylori testing is more appropriate when the presentation is dyspepsia without classic GERD features or when ulcer disease is suspected. Antacids can offer short-term relief but don’t address ongoing acid production or healing. In this scenario, beginning a PPI provides the most effective, evidence-based initial management.

Typical gastroesophageal reflux disease symptoms in a young adult without red flags are best addressed with acid suppression using a proton-pump inhibitor. This class of medication directly reduces gastric acid production, which decreases irritation of the esophagus, promotes healing if esophagitis is present, and provides more reliable and lasting symptom relief than antacids. Starting a PPI gives a clear test of whether acid reflux is driving the symptoms, with a plan to reassess after a course of therapy.

Endoscopy is reserved for alarm features (such as weight loss, persistent vomiting, GI bleeding, trouble swallowing) or for patients with symptoms that do not respond to initial therapy. H. pylori testing is more appropriate when the presentation is dyspepsia without classic GERD features or when ulcer disease is suspected. Antacids can offer short-term relief but don’t address ongoing acid production or healing. In this scenario, beginning a PPI provides the most effective, evidence-based initial management.