Maximum Views Reached

You have reached the maximum number of Guideline views for today. By creating a free account, you can increase your number of complimentary daily views.

To view this Guideline, please log in to your account. If you do not have an account, you can create one for free by clicking the button below.

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