DR BURNS: Mrs J is a 59-year-old woman with
a long history of gastroesophageal reflux disease (GERD) and documented Barrett
esophagus. She lives near Boston with her husband and has 2 grown children.
She sees her primary care physician, Dr W, and she has managed care insurance.
Mrs J initially developed symptoms of heartburn in the early 1990s and
was prescribed ranitidine, 150 mg/d, which was later increased to twice daily
without improvement. In 1993, Mrs J underwent an upper GI series, the results
of which were normal; in 1994, test results for Helicobacter
pylori were negative.
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