A generally healthy 22-year-old graduate student was seen twelve weeks ago with episodic postprandial epigastric burning

A generally healthy 22-year-old graduate student was seen twelve weeks ago with episodic postprandial epigastric burning. This had been bothering her for nearly six months but she was busy with school and was unable to find time for an appointment. She reported this year has been particularly stressful, resulting in increased consumption of coffee and fast food. At that visit, she began an eight-week trial of omeprazole and cut back on caffeine and fatty foods. She returns now with no improvement of her symptoms. She has no new symptoms, and physical exam is unremarkable. Which of the following is the most appropriate next step in her management? Choose the single best answer. A. Administer a urea breath test B. Begin treatment with triple therapy of pantoprazole, clarithromycin, and azithromycin for 14 days C. Continue omeprazole for another four weeks with close follow-up D. Refer her for an upper gastrointestinal endoscopy E. Switch PPI from omeprazole to pantoprazole

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