37 year old woman who complains of severe heartburn.
History of the Present Illness:
This woman had gastric banding for weight reduction 8 months
ago. There were no complications in the immediate post-operative period. She
has lost 95 pounds since her operation. Severe symptoms began 5 months after
the operation. She has been complaining of severe burning sensation in her
mid-chest for approximately 3 months. She also has food regurgitation. She
has symptoms in the daytime as well as in the nightime and it makes no difference
whether she is sitting up or lying on her back. She has had nasal regurgitation
as well. She denies dysphagia but does have burning when she swallows. She
vomits after most meals. The vomitus is occassionally blood streaked. She
has had episodes of coffee ground emesis. The patient complains of frequent
coughing as well as hoarseness. The patient has had some benefit from proton
pump inhibitors.
Previous Medical Diagnoses, Hospitalizations, and Operations:
Morbid obesity for many years. History of bilateral ureteral
reflux. Left nephrectomy and reimplantation of her right ureter in 1994. High
blood pressure.
Medications:
Lansoprazole 30 mg po bid.
Personal and Social History:
Patient is married and has one child. She works as a banker.
There is no history of alcohol, tobacco, or illegal drug use. Recent travel
to Mexico and Syria.
Family History:
Patient's mother has SLE as well as a past history of ulcer
disease. Her father has coronary artery disease. Her child is healthy.
