Gastro-oesophageal reflux disease in an obese patient

A 45-year-old woman, with a body mass index of 41.8 kg/m2 and a medical history of anxiety-depression syndrome, had iatrogenic hypothyroidism and degenerative osteoarticular pathology of the spinal column and complained of a burning sensation behind the sternum associated with an acidic taste in her mouth. Symptoms had appeared 3 months previously and were especially prevalent when lying down, following large meals or after drinking coffee. The patient had started to experience symptoms on most days approximately 1 month earlier. Upper digestive endoscopy (UDE) revealed isolated erosions of the distal third of the oesophagus, compatible with a diagnosis of erosive reflux oesophagitis. Lifestyle changes were recommended and 8 weeks' treatment with pantoprazole 40 mg/day taken 15-30 minutes before breakfast was prescribed. Follow-up UDE showed resolution of oesophageal lesions with no pathological changes of the mucosa. Mild regurgitation and pyrosis persisted; therefore the patient continued to receive pantoprazole 40 mg for a further 3 weeks.