K.T. is a 65-year-old male who presents with burning pain in the middle of his chest about one hour after a meal

K.T. is a 65-year-old male who presents with burning pain in the middle of his chest about one hour after a meal.  He reports that although he sleeps on 3 pillows he sometimes awakens at night with burning and regurgitation.  He states that he has been having these symptoms on and off for years and he usually takes an antacid and it gets better.  That is no longer working and he states that sometimes he has trouble getting food down.  It seems to get stuck behind his breastbone.  K.T. states that this problem is interfering with his quality of life and he wants it to stop.

PMH

• HTN x 15 years
• Alcoholic cirrhosis x 2 years
• Hiatal hernia

Social History

• Retired college basketball coach
• Enjoys cooking, traveling, gourmet dining and playing poker
• Caffeine; 5 cups of coffee/day
• EtOH: history of heavy alcohol use; current consumption is 6 beers with shots/week.
• Smoking 55 pack-year history, currently smokes ¾ ppd

Meds

• Verapamil SR 120 mg po QD
• Hydrochlorothiazide 25 mg po QD
• Famotidine 20 mg po Q HS
  1. What are the top 2-3 diagnoses to think about for this patient’s symptoms and what is most likely diagnosis?