Question 29 Answer

Answer: C. Trial of proton pump inhibitors (PPI).

Peak gastric acid secretion occurs during the early morning hours between 1 a.m. and 3 a.m., with a typical scenario of being awakened from sleep.

The shared afferent neural pathway makes the pain of gastroesophageal reflux disease (GERD) often similar to that of pain of cardiac origin. Gastric acid secretion is lowest at approximately 6 am, so awakening in the morning with pain from GERD is unusual.