A 50-year Old Female Complains Of Wakening Up At Night

Posted on Wed, 7 Nov 2018

Wed, 7 Nov 2018 Answered on

Last reviewed on

Question : A 50-year old female complains of wakening up at night with a bitter taste in her mouth about four times per week for the past two months. It is interfering with her sleep and she is concerned.
what is the Pertinent positive and negative information?
What is Differential and working diagnosis?
Treatment plan, including: pharmacotherapy with complementary and OTC?
diagnostics (labs and testing)?

Answered by Dr. Dr. Prasad J (3 hours later)

Brief Answer:
Seems like GERD...

Detailed Answer:
Hi,

The details match description of GERD - "Gastro esophageal Reflux Disease" or simply acid reflux.

1. I would want to know the following information
- Duration of symptoms
- H/o abdominal pain / fullness / nausea / vomiting / chest pain
- H/o Breathing difficulty / Orthopnea / PND
- H/o nasal congestion / headache / fever
- Body Mass Index

2. Differential's to consider are Hiatus Hernia, Post nasal drip (infected) and Sleep apnea. Hiatus Hernia is a very close probability. The information provided are not sufficient to rule out Post nasal drip and Sleep Apnea.

3. I would began testing with Chest X-ray, Oesophageal manometry and endoscopy.

4. I choose to treat with a proton pump inhibitors and prokinetic medications. Antacids available as OTC are helpful too. Dietary and life style changes with weight management will also aid in the treatment. Sleeping with headend elevated will also lower recurrence / prevent acid reflux.
Rarely surgical means are advised as treatment.

Hope I have answered all your questions. Let me know if you need any other information.

Regards

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Above answer was peer-reviewed by : Dr. Prasad