A 28-Year-Old Primigravid Woman at 24 Weeks Gestation Comes to the Office

A 28-year-old primigravid woman at 24 weeks gestation comes to the office due to heartburn and nausea.  Over the last several weeks she has also had retrosternal and epigastric pain after eating.  Although the patient uses 2 pillows to sleep and avoids spicy food, she awakens several nights a week due to heartburn and regurgitation.  The symptoms started a month ago and have been minimally responsive to over-the-counter antacids.
The patient has a history of heartburn prior to pregnancy, which she managed with dietary changes and over-the-counter antacids.  Her father died from esophageal cancer at age 60.  The patient does not use tobacco, alcohol, or illicit drugs.  She takes a multivitamin daily.
Which of the following is the most appropriate management for this patient?

A) Acid-neutralizing therapy
B) Acid-reducing therapy
C) Esophageal manometry
D) Esophagogastroduodenoscopy
E) Low-fat diet and metoclopramide

Correct Answer:

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