Diagnosis and Management of Gastroesophageal Reflux Disease
Publication Date: November 22, 2021
Last Updated: March 14, 2022
Diagnosis of GERD
|
Recommendation
|
GRADE Quality of Evidence | GRADE Strength of Recommendation |
| For patients with classic GERD symptoms of heartburn and regurgitation who have no alarm symptoms, we recommend an 8-wk trial of empiric PPIs once daily before a meal. | Moderate | Strong |
| We recommend attempting to discontinue the PPIs in patients whose classic GERD symptoms respond to an 8-wk empiric trial of PPIs. | Low | Conditional |
| In patients with chest pain who have had adequate evaluation to exclude heart disease, objective testing for GERD (endoscopy and/or reflux monitoring) is recommended. | Low | Conditional |
| We do not recommend the use of a barium swallow solely as a diagnostic test for GERD. | Low | Conditional |
| We recommend endoscopy as the first test for evaluation of patients presenting with dysphagia or other alarm symptoms (weight loss and GI bleeding) and for patients with multiple risk factors for Barrett's esophagus. | Low | Strong |
| In patients for whom the diagnosis of GERD is suspected but not clear, and endoscopy shows no objective evidence of GERD, we recommend reflux monitoring be performed off therapy to establish the diagnosis. | Low | Strong |
| We suggest against performing reflux monitoring off therapy solely as a diagnostic test for GERD in patients known to have endoscopic evidence of LA grade C or D reflux esophagitis or in patients known to have long-segment Barrett's esophagus. | Low | Strong |
GERD Management
|
Recommendation
|
GRADE Quality of Evidence | GRADE Strength of Recommendation |
| We recommend weight loss in overweight and obese patients for improvement of GERD symptoms. | Moderate | Strong |
| We suggest avoiding meals within 2–3 hr of bedtime. | Low | Conditional |
| We suggest avoidance of tobacco products/smoking in patients with GERD symptoms. | Low | Conditional |
| We suggest avoidance of “trigger foods” for GERD symptom control. | Low | Conditional |
| We suggest elevating head of bed for nighttime GERD symptoms. | Low | Conditional |
| We recommend treatment with PPIs over treatment with H2RA for healing EE. | High | Strong |
| We recommend treatment with PPIs over H2RA for maintenance of healing for EE. | Moderate | Strong |
| We recommend PPI administration 30–60 min before a meal rather than at bedtime for GERD symptom control. | Moderate | Strong |
| For patients with GERD who do not have EE or Barrett's esophagus, and whose symptoms have resolved with PPI therapy, an attempt should be made to discontinue PPIs | Low | Conditional |
| For patients with GERD who require maintenance therapy with PPIs, the PPIs should be administered in the lowest dose that effectively controls GERD symptoms and maintains healing of reflux esophagitis. | Low | Conditional |
| We recommend against routine addition of medical therapies in PPI nonresponders. | Moderate | Conditional |
| We recommend maintenance PPI therapy indefinitely or antireflux surgery for patients with LA grade C or D esophagitis. | Moderate | Strong |
| We do not recommend baclofen in the absence of objective evidence of GERD. | Moderate | Strong |
| We recommend against treatment with a prokinetic agent of any kind for GERD therapy unless there is objective evidence of gastroparesis. | Low | Strong |
| We do not recommend sucralfate for GERD therapy except during pregnancy. | Low | Strong |
| We suggest on-demand/or intermittent PPI therapy for heartburn symptom control in patients with NERD. | Low | Conditional |
Overview
Title
Diagnosis and Management of Gastroesophageal Reflux Disease
Authoring Organization
Feedback