Gastroesophageal Reflux Disease (GERD)
Key Points
Key Points
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
...essment...
...ostic Tests...
...with biopsy is recommended in patients with...
...ine endoscopy in subjects with erosive or nonero...
...is recommended to evaluate GERD patients who...
...impedance-pH, catheter pH, or wireless pH monito...
...gure 1. Patient With GERD-Relat...
Management
...nagemen...
...ifestyle Modificatio...
...ight loss should be advised for overweight or ob...
...of the head of the bed, avoiding recu...
...nt Directed Thera...
...tacids and over-the-counter (OTC) acid suppre...
...ymptoms persist, continuous therapy w...
...symptoms or signs develop, the patient s...
...cretory Therapies...
...is the mainstay therapy for GERD. (I)41...
...the most rapid symptomatic relief and healin...
...though less effective than PPIs*,...
...ce-daily PPI* therapy is recommended...
...tsPromotility agents may be used in selected p...
...tmentBecause GERD is a chronic conditi...
...Chest Pain SyndromeTwice-daily PPI* therapy is re...
...raesophageal Reflux Syndromes...
...and maintenance therapy with twice-daily PPIs* is...
...is refractory to medical therapy is...
...ndications for Antireflux Surgery
...doscopic therapy has no role in GERD tr...
...lux surgery, performed by an experienced surge...
...nsive to acid suppressive therapy. (II)Remark...
...ntireflux surgery is not recommended as an ant...
Table 1. Treatment Regimens for GERD
...ble 1. Treatment Regimens for GERD Havi...