This case involves a sixty-five-year-old Caucasian male and a delayed diagnosis of gastroesophageal reflex disease (GERD). At age 50, this patient began to have symptoms including chest pain, nocturnal cough, and shortness of breath. The patient had a 30-year history of smoking and daily alcohol consumption. His primary care physician did an entire cardiopulmonary work-up, including cardiac enzymes and EKG, to rule out myocardial infarction, as well as pulmonary function tests to rule-out lung pathology. The patient began experiencing swallowing difficulties with some non-specific symptoms of fever, weight loss, and general malaise. Barium swallow showed obstruction in the lower 1/3 of the esophagus. Biopsy confirmed the diagnosis of stage 4 esophageal adenocarcinoma. The lesion was too advanced for surgery and the patient was initiated on chemotherapy. Six months later, the patient expired.
Question(s) For Expert Witness
1. Could a diagnosis of GERD been made earlier and what effects on survival would it have?
Expert Witness Response
An earlier diagnosis of GERD could have been made based upon proper history taking and further testing. Patient should have been asked about diet and lifestyle due to the fact that spicy foods, smoking, alcohol use, caffeine, hot drinks and smoked foods can all contribute to GERD. Acidity of the esophagus could have been evaluated by a physician either through pH testing or response to antacids. After the development of GERD, and before the development of cancer, patients develop an intermediate condition called Barrett’s esophagus. If GERD or Barrett’s was found, patient could have been started on a proton pump inhibitor, or other antacid, to combat these conditions. This would stop the progression to full carcinoma. Once the patient develops esophageal cancer, it is almost always fatal.
About the author
Jason Cohn
Jason is a 4th year medical student pursuing a career in Otolaryngology/Facial Plastic Surgery. His Interest include sports, fitness, chemistry, otolaryngology, plastic surgery, allergy/immunology, surgical oncology, human genetics, public health, preventative medicine, and rheumatology.
