Assignment task:
A 55-year-old male with PMH of myocardial infarction s/p stent two years ago is complaining of sharp epigastric pain worsening over four months. He had been taking rabeprazole for GERD, and endoscopy previously revealed erosive esophagitis. The pain does not radiate, but it has become constant throughout the day. He describes it as 5/10 at the most severe, although it waxes and wanes. It is not associated with eating, but it is increased when he is supine. It is not associated with exertion. He complains of dysphagia and nausea. He also has a chronic cough (nonproductive.) Which of the following considerations is accurate concerning this patient's evaluation and management?
A. Prevention of long-term complications including Barrett esophagus and esophageal adenocarcinoma is superior in patients with chronic GERD who undergo surgical treatment.
B. Omeprazole has been more effective than rabeprazole for treatment of GERD with erosive esophagitis.
C. The most frequent indication for surgery in patients with GERD is severe GERD unresponsive to optimal medical therapy.
D. PPIs have shown no difference compared to placebo in improving cough in patients with GERD.