Question: BB’s, A 58-year-old Obese Man, Comes To His Primary Care Provider Because He Has Difficulty Swallowing, Has Heartburn, And Experiences Occasional Regurgitation. Answering His Provider’s Questions, Mr. B Says That His Symptoms Worsen When He Drinks Coffee Or Alcohol. Today, Endoscopy Reveals Inflammation In His Lower Esophagus And Poor Closure Of The …

BB’s, a 58-year-old obese man, comes to his primary careprovider because he has difficulty swallowing, has heartburn, andexperiences occasional regurgitation. Answering his provider’squestions, Mr. B says that his symptoms worsen when he drinkscoffee or alcohol.

Today, endoscopy reveals inflammation in his lower esophagus andpoor closure of the lower esophageal sphincter. There is noevidence of esophageal narrowing or movement of the proximalstomach into the thorax.

The provider diagnoses gastroesophageal reflux disease(GERD).

1. Why did his provider check to see if Mr. B had movement of theproximal stomach into the thorax?
2. What is the mechanism by which obesity contributes toGERD?
3. What is metaplasia? Why does it occur?
4. Why might reducing his intake of caffeine and alcohol decreaseMr. B symptoms?
5. Are Mr. B symptoms of dysphagia, heartburn, and regurgitationspecific to GERD?
6. In addition to discomfort, what is a danger of untreatedGERD