Commentary: A clinical challengeBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7559.137 (Published 13 July 2006) Cite this as: BMJ 2006;333:137
- Robert Logan, consultant (email@example.com)1
- 1 Department of Gastroenterology, King's Mill Hospital, Sutton-in-Ashton NG17 4JL
Several learning points arise from Mr Neville's case.1 The most important relates to the diagnostic approach when we are challenged with pieces of a clinical puzzle that do not neatly fit together.
Gastro-oesophageal reflux disease usually poses few diagnostic challenges, especially when there is a good symptomatic response to empirical anti-secretory therapy. However, in this case, Mr Neville's poor response to treatment and persistent symptoms led to further investigation and several protracted stays in hospital. The normal oesophageal manometry …