a 52-year-old man presents with a 3-day history of persistent diarrhea. he reports seven watery, non-bloody bowel movements daily. he has associated lower-abdominal cramping and mild nausea. he denies recent travel out of the country. he does not recall eating anything unusual, and none of his family members are sick. past medical history is significant for gerd, for which he takes pantoprazole daily. he recently completed a course of oral levofloxacin for pneumonia. a stool sample is negative for

If a diarrhea lasts more than a few days and goes into weeks, it usually shows that there's another underlying issue for example: irritable bowel syndrome (IBS) or a another serious disorder.

Note therefore that the surgical treatment that can improve the patient's symptoms most efficiently is option 1: Laparoscopic fundoplication.

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A 52-year-old man presents with heartburn associated with reflux of sour-tasting material in the mouth. Some episodes are accompanied by increased salivation, coughing, and regurgitation of food. Episodes have become more frequent during the past 6 months despite treatment over several years with various treatment combinations, including antacids, histamine 2 receptor antagonists (H2RAs), and proton pump inhibitors (PPIs). He denies bleeding or abnormalities in his stool. He is slightly overweight and has mild hypertension, which is well-controlled with antihypertensive medication. Vital signs are within reference ranges, and the physical examination is unremarkable. Upper endoscopy reveals a large hiatal hernia and coalescing linear erosions throughout the esophageal circumference and a 5.5 cm circumferential cherry red patch above the gastroesophageal junction. Biopsy of the patch reveals columnar metaplasia, but no dysplasia.

What surgical treatment can improve the patient's symptoms most efficiently?

1 Laparoscopic fundoplication

2 Whipple procedure

3 Esophagectomy

4 Radiofrequency thermal coagulation of the lower esophageal wall

5 Laser ablation of the Barrett's mucosa