A 35-year-old male presents with heartburn that wakes him up at night. He has been using over-the-counter antacids and H2 blockers with partial relief. Recently he has also developed a hoarse voice. He denies any cough or weight loss. What could be the problem, and what are the next steps?
These symptoms are suggestive of GERD, potentially with laryngopharyngeal reflux given the hoarseness. The patient should be started on a trial of proton pump inhibitor therapy. If symptoms persist, further evaluation with an upper endoscopy or ambulatory pH monitoring could be considered. He should also be counseled on lifestyle modifications, including elevating the head of his bed, avoiding late-night meals, and avoiding foods that exacerbate his symptoms.