What is the most likely treatment to alleviate symptoms of a 35-year-old woman presenting with burning chest pain radiating to the neck and a bitter taste, with normal Electrocardiogram (ECG) and chest radiograph findings?

From the Guidelines

The most likely intervention to help this patient's symptoms is elimination of food triggers. The patient's presentation is consistent with gastroesophageal reflux disease (GERD), characterized by a burning chest pain that radiates upward from the subxiphoid area, along with a bitter taste in the mouth. These symptoms occur when stomach acid flows back into the esophagus. Food triggers commonly exacerbate GERD symptoms, including spicy foods, citrus, tomato-based products, chocolate, caffeine, and fatty meals. Patients should identify and avoid their specific triggers through an elimination diet. Additionally, other lifestyle modifications can help, such as eating smaller meals, avoiding lying down for 2-3 hours after eating, elevating the head of the bed, and maintaining a healthy weight. If dietary changes alone are insufficient, over-the-counter antacids, H2 blockers like famotidine, or proton pump inhibitors like omeprazole may be recommended. The normal ECG and chest radiograph findings support a non-cardiac, non-pulmonary cause of the symptoms, making GERD the most likely diagnosis requiring dietary modification as first-line treatment. Key points to consider in managing this patient's symptoms include:

• Identifying and avoiding specific food triggers through an elimination diet
• Implementing lifestyle modifications such as eating smaller meals and avoiding lying down after eating
• Considering over-the-counter antacids, H2 blockers, or proton pump inhibitors if dietary changes are insufficient
• Ruling out other causes of chest pain, especially esophageal dysmotility, if symptoms persist 1.

From the FDA Drug Label

Omeprazole delayed-release capsules are indicated for the treatment of heartburn and other symptoms associated with GERD for up to 4 weeks in patients 2 years of age and older. GERD happens when acid in your stomach backs up into the tube (esophagus) that connects your mouth to your stomach This may cause a burning feeling in your chest or throat, sour taste, or burping. The most likely option to help her symptoms is Elimination of food triggers.

• The patient's symptoms of burning pain in the subxiphoid area, radiating up into her neck, and bitter taste in her mouth are consistent with gastroesophageal reflux disease (GERD).
• Avoidance of alcohol and Elimination of food triggers may help alleviate GERD symptoms.
• Omeprazole, a proton pump inhibitor, is indicated for the treatment of GERD symptoms, but the question asks for the most likely option to help her symptoms, not medication.
• There is no direct information in the provided drug labels that supports the use of Calcium channel blocker therapy, Eradication of Helicobacter pylori, or Increased physical activity for the treatment of GERD symptoms in this patient 2, 2.

From the Research

Symptoms and Potential Causes

• The patient presents with burning chest pain that begins in the subxiphoid area and radiates up into her neck, along with a bitter taste in her mouth.
• Normal findings on ECG and chest radiograph suggest that the cause of her symptoms may not be related to cardiac issues.

Potential Treatments

• Based on the symptoms described, the patient may be experiencing gastroesophageal reflux disease (GERD) symptoms.
• The study 3 suggests that elimination of food triggers can be effective in treating symptoms of GERD, as most patients with GERD can identify at least one food that triggers their symptoms.
• Other options such as avoidance of alcohol, calcium channel blocker therapy, eradication of Helicobacter pylori, and increased physical activity may not be directly relevant to treating GERD symptoms.
• The study 4 discusses the use of combination therapy with proton-pump inhibitors and histamine(2) receptor antagonists for GERD, but does not provide evidence for the most effective treatment for the patient's specific symptoms.
• The studies 5, 6, and 7 provide information on the treatment of GERD and reflux esophagitis, but do not directly address the patient's symptoms and potential triggers.

Most Likely Treatment

• Based on the evidence, elimination of food triggers is the most likely treatment to help the patient's symptoms, as it has been shown to be effective in treating GERD symptoms in the short term 3.