16th July 2020

An 84-year-old male presents with a 2 year history of heartburn associated with eating

An 84-year-old male presents with a 2 year history of heartburn associated with eating. He has no dysphagia, weight loss, anaemia, anorexia or change in bowel habit. He has no family history of upper gastrointestinal cancer. He has a normal ECG. The patient has COPD, diabetes, osteoporosis and had a myocardial infarction last year. He takes a number of medications including bisphosphonates, metformin, aspirin, bisoprolol, clopidogrel atorvastatin and ramipril. He is also currently taking clarithromycin for an exacerbation of COPD.

The GP suggests trying lifestyle interventions to manage what he suspects is gastro-oesophageal reflux disease (GORD). He also decides to stop one of the patient’s medications which he believes could be worsening the reflux.

Which of his medications could be a contributing factor to his heartburn?

Which is the SINGLE most appropriate option from the list below? Select ONE option only.