Gastroesophageal Reflux Disease (GERD)
Key Points
Key Points
- The only other lifestyle modification that has sufficient evidence to support its efficacy is elevating the head of the bed.
- In case of chest pain, a cardiac cause must first be ruled out.
- Chronic cough, laryngitis, and asthma due to GERD may present atypically without accompanying esophageal symptoms.
- Long-term treatment of esophageal symptoms, but not extra-esophageal symptoms, with lowest effective dose PPI* is recommended.
- Antireflux surgery is successful when patients demonstrate good PPI* response.
- Progression from nonerosive disease to erosive esophagitis to Barrett’s esophagus is distinctly unusual. Endoscopic monitoring of patients with chronic GERD is limited to excluding Barrett’s esophagus once in a lifetime.
- No direct evidence supports routine biopsy (when a suspicious lesion is absent).
- The use of endoscopy as a screening test for Barrett’s esophagus or esophageal adenocarcinoma in the setting of chronic GERD remains an area of intense controversy, but one endoscopy during a patient’s lifetime to rule-out Barrett’s esophagus is recommended.
* Proton pump inhibitors may increase the risk of fractures of the hip, wrist, and spine with high-dose or chronic use.
Assessment
Assessmen...
...ostic Tests...
...th biopsy is recommended in patients with...
...py in subjects with erosive or noner...
...is recommended to evaluate GERD patients who are...
...bulatory impedance-pH, catheter pH, or...
.... Patient With GERD-Related Symptoms...
Management
...nagement
...estyle Modifications ...
...ght loss should be advised for overweight or obes...
...ion of the head of the bed, avoidi...
Patient Directed...
...and over-the-counter (OTC) acid suppr...
...oms persist, continuous therapy with H2RAs or PPI*...
...hen alarm symptoms or signs develop, the pati...
...ecretory Therapies...
...ppression is the mainstay therapy for GERD...
...e the most rapid symptomatic relief and healing...
...gh less effective than PPIs*, HRAs g...
...therapy is recommended for patients with atypica...
...motility AgentsPromotility agents may be u...
Duration of TreatmentBecause GERD is a...
...x Chest Pain SyndromeTwice-daily PPI* therapy is...
...ected Extraesophageal Reflux Syndromes
...cute and maintenance therapy with twice-dail...
...is refractory to medical therapy is not...
...ndications for Antireflux S...
...endoscopic therapy has no role in GERD tre...
...surgery, performed by an experienced surgeon,...
...ive to acid suppressive therapy. (II)Remark: Th...
...ntireflux surgery is not recommende...
Table 1. Treatment Regimens for GERD
...e 1. Treatment Regimens for GERD Ha...