NS465 Unit 10 Reflux Functional Case Study Example

A Referral Before Any Food: A Unit 10 Functional Case Study of a House Painter on Two Years of Daily Antacids

[Student Name]

Purdue University Global

NS465: Functional Nutrition

Unit 10 Functional Case Study

[Instructor Name]

[Date]

The client and every detail of his case are composite; the reflux guideline, the meal-timing study and the lifestyle review cited are real.

Client Introduction

Marcus is 48 and runs a one-person house painting business. He came in because his wife told him to: he has taken chewable antacids every day for about two years, sometimes six or eight tablets a day, for burning in his chest after meals and at night. He has never seen a physician about it. He wanted "a diet to fix my stomach."

Intake

His day starts at 6 a.m. with no breakfast and the first of three energy drinks. He paints from 7 until 4 or 5, usually skipping lunch or eating a gas station sandwich in the van. He drinks a second and third energy drink by noon. He gets home around 6, handles invoices and calls, and eats dinner at about 9, typically a large plate of meat, rice and beans, often with hot sauce, followed by two beers. He goes to bed by 9:45 and often wakes around 1 a.m. with burning and a sour taste. He has gained about 20 pounds over five years and goes through about ten cigarettes on a working day.

Near the end of the intake I asked whether food ever seemed to stick on the way down. He paused and said that for the last two months, bread and meat sometimes felt stuck behind his breastbone, and he had to drink water to push them down. He had not mentioned it because he thought it was part of the heartburn.

The Referral

I stopped the nutrition part of the intake there. Trouble swallowing is an alarm feature in someone with long-standing reflux. The gastroenterology guideline on reflux recommends that people with alarm symptoms such as difficulty swallowing, weight loss or bleeding have an upper endoscopy rather than simply continuing treatment (Katz et al., 2022). Two years of near-daily heartburn treated only with antacids, at his age and with his smoking history, adds to the reason for a physician's assessment.

No eating plan should begin until a physician has looked at why food is sticking, because a diet that eases his heartburn could also hide a problem that needs diagnosis.

I explained this to Marcus plainly, without alarming him: difficulty swallowing has several causes, many of them treatable, but it needs to be checked. He agreed to call his primary care physician the next morning, and I wrote a short note for him to bring, listing his symptoms, how long he had had them and how many antacids he takes. We agreed to meet again after his visit.

After the Physician Visit

Marcus returned three weeks later. His physician had referred him for an endoscopy, which found inflammation of the esophagus and a narrowing that was stretched during the procedure. He was prescribed a daily acid-reducing medicine and told that weight loss, stopping smoking and changing his meal timing would help. His physician asked that nutrition work focus on those lifestyle changes. With that medical plan in place, nutrition could begin.

Functional Assessment

Organizing his history by system shows where nutrition can help. Digestion is the obvious system: reflux, made worse by large late meals. Energy and sleep are tied in: night waking from reflux cuts his sleep, and the morning energy drinks fill the gap that broken sleep leaves, which may add to his symptoms. Body weight sits underneath: abdominal weight gain increases pressure on the stomach. Lifestyle factors include smoking, beer at night and a workday with no planned meals.

Evidence for the Plan

Lifestyle changes with the clearest support in reflux include weight loss, stopping smoking, avoiding late meals and raising the head of the bed (Ness-Jensen et al., 2016). In a study of patients with reflux, those whose dinner-to-bed interval was under three hours had about seven times the odds of reflux disease compared with those who waited four hours or more (Fujiwara et al., 2005). Marcus currently goes to bed 45 minutes after dinner.

The Plan

The plan was built with Marcus around his working day, in three steps over six weeks.

First, move the main meal earlier. Marcus will eat a substantial lunch at 12:30, packed from the previous night's leftovers, and a smaller dinner by 7 p.m., at least three hours before bed. Invoices move to after dinner.

Second, reduce the energy drinks gradually. He will drop from three to two in the first two weeks, then to one, replacing the others with water and a breakfast of eggs and toast or peanut butter on whole-grain bread. Cutting all three at once would likely cause headaches and fatigue on the job.

Third, adjust the evening. He will move his beers to earlier in the evening and limit them to one on work nights, and he will prop up the top end of his bed frame by about six inches.

Smoking cessation was referred back to his physician, who offered treatment. Weight loss is expected to follow from the meal changes and fewer energy drinks and beers, and is not set as a target for the first six weeks.

Why the Energy Drinks Come Down Slowly

Marcus was surprised that the plan did not ask him to stop the energy drinks at once. Each can holds a substantial dose of caffeine, and three by noon add up to far more than most adults drink. Stopping suddenly can bring headaches, irritability and fatigue for several days, which on a ladder with a roller in his hand is a safety issue as well as a comfort one. A gradual step-down also gives the earlier breakfast time to take over some of the job the drinks were doing. The goal is not to remove caffeine from his life but to reduce a habit that may be adding to his symptoms and is certainly covering for lost sleep.

Monitoring

Marcus will keep a simple log of dinner time, number of energy drinks, number of beers and nights woken by heartburn. His physician will manage his medicine and decide on any follow-up endoscopy.

Reflection on the Case

The most important decision in this case was not a food choice. It was noticing a symptom Marcus thought was minor and stopping to send him to his physician. A plan built on his first request, a diet to fix his stomach, might have reduced his heartburn for a while and delayed the diagnosis of a narrowed esophagus. Functional nutrition's strength is looking at the whole story, and this case shows that the whole story sometimes points away from nutrition before it points back.

References

Fujiwara, Y., Machida, A., Watanabe, Y., Shiba, M., Tominaga, K., Watanabe, T., Oshitani, N., Higuchi, K., & Arakawa, T. (2005). Association between dinner-to-bed time and gastro-esophageal reflux disease. American Journal of Gastroenterology, 100(12), 2633-2636. https://doi.org/10.1111/j.1572-0241.2005.00354.x

Katz, P. O., Dunbar, K. B., Schnoll-Sussman, F. H., Greer, K. B., Yadlapati, R., & Spechler, S. J. (2022). ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. American Journal of Gastroenterology, 117(1), 27-56. https://doi.org/10.14309/ajg.0000000000001538

Ness-Jensen, E., Hveem, K., El-Serag, H., & Lagergren, J. (2016). Lifestyle intervention in gastroesophageal reflux disease. Clinical Gastroenterology and Hepatology, 14(2), 175-182. https://doi.org/10.1016/j.cgh.2015.04.176