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
...ssessmen...
Diagnostic Test...
...py with biopsy is recommended in patients with GER...
...endoscopy in subjects with erosive or nonero...
...is recommended to evaluate GERD patient...
...edance-pH, catheter pH, or wireless pH monitori...
...atient With GERD-Related Symptoms...
Management
...anagement...
...ifestyle Modifica...
...ight loss should be advised for overweight or o...
...vise elevation of the head of the bed, avoidin...
...t Directed Therapy...
...nd over-the-counter (OTC) acid suppre...
...persist, continuous therapy with H2RAs or P...
...ymptoms or signs develop, the patient should...
Antisecretory Th...
...suppression is the mainstay therapy for...
...provide the most rapid symptomatic relief and...
...though less effective than PPIs*, HRAs given in...
...I* therapy is recommended for patient...
...otility AgentsPromotility agents may be used in s...
...ration of TreatmentBecause GERD is a...
...ected Reflux Chest Pain SyndromeTwice-daily PPI* t...
...Extraesophageal Reflux Syndromes
...and maintenance therapy with twice-daily PPI...
...is refractory to medical therapy is not co...
...for Antireflux Surgery
Presently, endoscopic therapy has no role in...
...surgery, performed by an experience...
...ive to acid suppressive therapy. (II)Rema...
...reflux surgery is not recommended as an antineop...
Table 1. Treatment Regimens for GERD
...1. Treatment Regimens for GERD Having tr...