Gastroesophageal Reflux Disease (GERD)
Key Points
Key Points
- The only other lifestyle modification that has sufficient evidence to support its efficacy is elevating the head of the bed.
- 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
...sessment...
...gnostic Test...
Endoscopy with biopsy is recommended in pati...
...ne endoscopy in subjects with erosive or noner...
...y is recommended to evaluate GERD patients...
...ulatory impedance-pH, catheter pH,...
.... Patient With GERD-Related Sym...
Management
...anagemen...
...style Modifications ...
...ould be advised for overweight or...
...dvise elevation of the head of the bed, a...
...tient Directed Ther...
...ds and over-the-counter (OTC) acid suppressa...
...toms persist, continuous therapy with H2RA...
When alarm symptoms or signs develop, t...
...ntisecretory Therapies...
...sion is the mainstay therapy for GER...
...he most rapid symptomatic relief and healing of e...
...though less effective than PPIs*, HRAs given in di...
...e-daily PPI* therapy is recommended for p...
...AgentsPromotility agents may be use...
...ation of TreatmentBecause GERD is...
...ed Reflux Chest Pain SyndromeTwice-dail...
...spected Extraesophageal Reflux Syndrom...
...ute and maintenance therapy with twice-daily PPI...
...t is refractory to medical therapy is not...
...s for Antireflux Surgery...
...tly, endoscopic therapy has no role in...
...tireflux surgery, performed by an expe...
...ve to acid suppressive therapy. (II)Rema...
...tireflux surgery is not recommended as...
Table 1. Treatment Regimens for GERD
...ment Regimens for GERD Having trouble viewing...