Practice

Commentary: A clinical challenge

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7559.137 (Published 13 July 2006) Cite this as: BMJ 2006;333:137
  1. Robert Logan, consultant (robert.logan@nottingham.ac.uk)1
  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 …

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