A 30-year-old male presents with recurrent chest pain that gets worse when lying down and improves with sitting up and antacids. His cardiac workup has been negative. He is concerned that these symptoms are affecting his quality of life. What could be the problem, and what are the next steps?
This patient's recurrent chest pain that improves with antacids and changes in position is suggestive of gastroesophageal reflux disease (GERD). The negative cardiac workup further supports this diagnosis. The next steps could include lifestyle changes such as weight loss, elevation of the head of the bed, and dietary modifications. Medical treatment with a proton pump inhibitor (PPI) should be considered, and if symptoms persist despite these measures, further investigations like endoscopy or ambulatory acid (pH) probe tests may be necessary.