A 53-year-old man presents with increased difficulty swallowing and occasional regurgitation of his meals. His symptoms have been occurring with greater frequency and severity over the last 4 months. He also gets some shortness of breath, but attributes that to his weight and lack of physical activity.

His past medical history is remarkable for chronic heartburn, which he treats intermittently with over the counter antacids. He takes no regular medications, and he has no allergies. He has not had any surgeries. He is smoker, but he denies use of alcohol and drugs. He works as a building inspector, and he lives with his wife and children.

The patient is obese, but the rest of his physical exam is normal. Blood tests, electrocardiogram, and chest X-ray are done in the clinic; they are normal. He is referred for endoscopy, and esophageal biopsy shows specialized intestinal metaplastic cells (of columnar epithelium).


What recommendation would best prevent complications from this patient's current condition?

A) Avoidance of antacids
B) Referral for fundoplication
C) Regular exercise
D) Use of proton pump inhibitors
E) Weight loss