Mr. M.J. is a 64-year-old patient of Hispanic descent who presents to the clinic today with concerns about epigastric and substernal pain that has gotten progressively worse over the past 3 months.

Mr. M.J. is a 64-year-old patient of Hispanic descent who presents to the clinic today with concerns about epigastric and substernal pain that has gotten progressively worse over the past 3 months. He complains of mild “heartburn after eating a large meal for at least 2 years. He has tried over the counter products occasionally with adequate response. Three months ago, he was awakened with severe burning discomfort that extended from his mid-chest to his jaw that lasted 30 minutes before he was able to fall back to sleep. He is now experiencing these attacks about 3 times per week. He has tried avoiding large meals and is now sleeping on two pillows at night to relieve his pain which has improved his pain. The pain now occurs regularly after meals and randomly during the day. He takes antacids with each meal, but the pain still persists. Overall, he considers himself to be very healthy.

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Past Medical History

Depression diagnosed 6 months ago

Family History

Unknown; was adopted from an orphanage when he was 3 months old; Wife died of breast cancer approximately 8 months ago. They were unable to have children.

Social History

Drinks beer occasionally when out with friends

No smoking history

Current Medications

Multivitamin daily

Discussion Questions Part One

• Describe how you would work-up this patient’s abdominal pain based on current clinical guidelines.
• Provide further ROS questions needed to develop differential diagnoses.
• Provide the differential diagnoses (DD) with rationale.
• Decide whether or not this patient should also be worked-up for depression. Why or why not?
• Based on the data provided, what types of screening tools would be useful in this patient’s case?