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Robert Glickman, MD

JAMA. 1995;274(6):495-500.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

Dr Daley

: Mr H is a 35-year-old registered nurse who has recurrent episodes of epigastric pain. Divorced and the father of one child, he works in a local hospital and receives private health insurance through his employer.

Since he was a child, Mr H has experienced intermittent pain in the epigastric area that radiates to the back. When the pain is mild, he describes it as burning, sometimes accompanied by chest heaviness or tightness. When the pain is severe, Mr H describes it as "a hot knife being pushed under my rib cage and out my back." His symptoms are aggravated by emotional stress, alcohol, cigarettes, and spicy foods. He denies nausea, vomiting, melena, hematemesis, symptoms of reflux, or anemia. He has never taken aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs). For many years, he took large quantities of antacids to relieve the pain, and sucralfate and cimetidine have also provided . . . [Full Text PDF of this Article]

Footnotes
Dr Glickman is Herrman L. Blumgart Professor of Medicine at Harvard Medical School and Chair of the Department of Internal Medicine, Beth Israel Hospital.

This conference took place at the Medicine Grand Rounds of the Beth Israel Hospital, Boston, Mass, on December 1, 1994.

Reprint requests to Division of General Medicine and Primary Care, Beth Israel Hospital, 330 Brookline Ave, LY339, Boston, MA 02215 (Ms Walzer).

Clinical Crossroads at Boston's Beth Israel Hospital is produced and edited by Thomas L. Delbanco, MD, and Jennifer Daley, MD; Janet Walzer, MEd, is managing editor. Clinical Crossroads section editor: Margaret A. Winker, MD, Senior Editor, JAMA.

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