Management of Gastroesophageal Reflux Disease in a Middle‑Aged Male with Helicobacter pylori Infection
History
A 48‑year‑old male presented with retrosternal burning persisting for ~5 years, initially 1–2 times per week post‑prandially, now occurring daily and nocturnally. Associated symptoms included cough, regurgitation, acidic taste, postprandial fullness, and early satiety, worsened by spicy food, bending, or lying flat. Sleep was significantly disturbed.
He reported recurrent shortness of breath over 4 years, diagnosed as bronchitis, with severe cough episodes often stress‑related and occasionally concurrent with heartburn. Past history included maxillary sinusitis and frequent sore throat.
Lifestyle factors revealed irregular meals, high work stress, and self‑medication with over‑the‑counter ranitidine, which provided only temporary relief. He denied nausea, vomiting, dysphagia, weight loss, melena, or altered bowel habits. Occasional smoking and alcohol use were noted. Physical activity was limited to walking 20–30 minutes, 1–2 times weekly.
Investigations
On examination, the patient was afebrile with stable vital signs (temperature 99°F, BP 130/78 mmHg, RR 18/min, pulse 80/min). Weight was 79 kg, BMI 32 (obese). No pallor, cyanosis, or icterus was noted. Intraoral examination revealed enamel erosion and enlarged tonsils. Chest movements were symmetrical; cardiac rhythm was regular without murmurs. The abdomen was soft, non‑tender, with normal bowel sounds.
Laboratory Results:
Hemoglobin: 13.7 g/dL; PCV: 0.35; WBC: 9,200/µL; Platelets: 403,000/µL
Fasting blood sugar: 125 mg/dL
BUN: 11 mg/dL; Creatinine: 1.2 mg/dL
AST: 15 U/L; ALT: 13 U/L
Sodium: 124 meq/L; Potassium: 3.29 meq/L
Albumin: 4.2 g/dL
Lipid profile: Total cholesterol 193 mg/dL, LDL 140 mg/dL, HDL 50 mg/dL, TG 66 mg/dL
Diagnosis
Patient presented with classic GERD symptoms that include heartburn (pyrosis) and regurgitation which carry high specificity and predictive value. In most cases, including this patient, clinical diagnosis is sufficient without confirmatory testing (1).
Management
Initial therapy with rabeprazole 20 mg daily was commenced. At 1‑month follow‑up, the patient reported worsening heartburn despite adherence, with persistent cough and sore throat. Domperidone 30 mg once daily was added to rabeprazole. After 12 weeks, regurgitation improved but symptoms persisted, and significant weight loss was noted.
Given the alarm feature of weight loss, further evaluation was undertaken. Helicobacter pylori infection was suspected and confirmed by stool testing. Therapy was modified to a triple regimen: amoxicillin 500 mg, clarithromycin 500 mg, and rabeprazole 20 mg twice daily for 10 days, administered before meals. For patients with peptic ulcer disease, an additional 18 days of rabeprazole 20 mg once daily is recommended. No dose adjustment was required for renal function.
Subsequent follow‑ups demonstrated good symptomatic relief, eradication of H. pylori, and improvement in cough and sore throat. Lifestyle modifications were reinforced: avoidance of coffee, chocolate, and fatty foods; weight reduction; smoking and alcohol cessation; elevating the head of the bed; and completing the last meal at least two hours before sleep.
Discussion
GERD arises from multiple mechanisms including transient lower esophageal sphincter relaxation, reduced sphincter pressure, hiatal hernia, impaired clearance, and diminished mucosal resistance. Most cases respond to non‑surgical measures. Antacids are appropriate initial therapy, but persistent or recurrent symptoms require escalation.
PPIs provide superior symptom relief compared to H2RAs (1, 2). Rabeprazole is particularly effective due to rapid activation, potent acid suppression, and greater antibacterial activity against H. pylori compared to omeprazole and lansoprazole (3). Cost‑effectiveness analyses also support PPIs as first‑line therapy (4).
The coexistence of GERD and H. pylori infection is common, though the relationship remains debated. In this patient, eradication therapy combined with PPI use resulted in symptom resolution and infection clearance. Long‑term acid suppression may still be required if GERD persists independently.
References
Armstrong D, et al. Canadian consensus conference on the management of gastroesophageal reflux disease in adults: update 2004. Can J Gastroenterol 2005;19(1):15-35.
Canadian Agency for Drugs and Technologies in Health. Evidence for PPI use in gastroesophageal reflux disease, dyspepsia, and peptic ulcer disease: scientific report. Optimal Therapy Report - COMPUS 2007;1(2).
Thjodleifsson B, Cockburn I. The role of Helicobacter pylori in gastroesophageal reflux disease. Aliment Pharmacol Ther. 1999;13(Suppl 5):17‑23.
Gerson LB, Robbins AS, Garber A, Hornberger J, Triadafilopoulos G. A cost‑effectiveness analysis of prescribing strategies in the management of gastroesophageal reflux disease. Am J Gastroenterol. 2000;95(2):395‑407.
About the author
Dr. Sheeba Rani is a Pharm.D graduate currently working as a medical writer, with growing expertise in medical data annotation. Passionate about clinical research and medical writing, she has a keen interest in exploring novel pharmacotherapeutic agents and leveraging data annotation techniques to advance patient care and healthcare innovation. Beyond her professional pursuits, Dr. Sheeba enjoys cooking and spending time outdoors, finding balance between science, creativity, and wellness.
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