Gastroesophageal Reflux Disease (GERD)

Publication Date: January 5, 2005

Key Points

Key Points

Weight loss should be advised for overweight and obese patients with GERD symptoms. (II)
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The only other lifestyle modification that has sufficient evidence to support its efficacy is elevating the head of the bed.

Antisecretory drugs recommended for patients with esophageal symptoms. (I)
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Proton pump inhibitors (PPIs*) are more effective than histamine2-receptor antagonists (H2RAs) for both symptoms and esophageal mucosal injury. (II)
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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

...Assessment...

...Diagnostic Tes...

...copy with biopsy is recommended in patients w...

...y in subjects with erosive or nonero...

...anometry is recommended to evaluate GERD patients...

...y impedance-pH, catheter pH, or wireless pH mon...

...igure 1. Patient With GERD-Relate...


Management

...Management...

...style Modifications...

...loss should be advised for overweight...

...evation of the head of the bed, avoiding recu...


...nt Directed Ther...

...er-the-counter (OTC) acid suppressants...

...ptoms persist, continuous therapy wi...

...mptoms or signs develop, the patient shou...


Antisecretory Therapie...

...uppression is the mainstay therapy...

...ide the most rapid symptomatic relie...

...less effective than PPIs*, HRAs given i...

...daily PPI* therapy is recommended for pa...


...lity AgentsPromotility agents may be used in...


...of TreatmentBecause GERD is a chro...


...pected Reflux Chest Pain SyndromeTwice-daily PPI*...


...aesophageal Reflux Syndromes...

...te and maintenance therapy with tw...

...refractory to medical therapy is not common. Fu...


...dications for Antireflux Su...

...sently, endoscopic therapy has no ro...

...ry, performed by an experienced surgeon, i...

...sponsive to acid suppressive therapy. (II)R...

...rgery is not recommended as an anti...


Table 1. Treatment Regimens for GERD 

...1. Treatment Regimens for GERD  Clas...