A 35-Year-Old Man Is Evaluated for Heartburn and a Sour

A 35-year-old man is evaluated for heartburn and a sour taste in his mouth.  The patient initially presented 2 months ago due to these symptoms, and a proton pump inhibitor was begun.  He has had mild relief but continues to have bothersome symptoms after his evening meal.  The patient has avoided drinking coffee and eating fatty or spicy foods, and he eats his evening meal at least 2 hours before bedtime.  He has had no weight loss, abdominal pain, nausea, vomiting, or black or tarry stools.  The patient has no other medical issues; his only medication is lansoprazole, which he takes 30 minutes before breakfast.  He works in a bank and does not use tobacco, alcohol, or illicit drugs.  His father was diagnosed with colon cancer at age 67.
Vital signs are within normal limits.  BMI is 28 kg/m².  Physical examination is unremarkable.
Laboratory results are as follows:
Which of the following is the most appropriate next step in management of this patient?

A) Advise esophageal pH and impedance testing
B) Change lansoprazole timing from morning to evening
C) Increase lansoprazole to 2 times per day
D) Perform upper gastrointestinal endoscopy
E) Test and treat for Helicobacter pylori

Correct Answer:

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