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
Assessmen...
...ostic Tests
...biopsy is recommended in patients with GERD...
...ine endoscopy in subjects with erosive or n...
...recommended to evaluate GERD patients who a...
...ulatory impedance-pH, catheter pH, or w...
...ure 1. Patient With GERD-Related Sym...
Management
...agement...
...e Modifications ...
...oss should be advised for overweight or ob...
...dvise elevation of the head of the bed, av...
Patient Directed Th...
...ver-the-counter (OTC) acid suppressants are o...
...hen symptoms persist, continuous therapy with H2...
...rm symptoms or signs develop, the patient should b...
Antisecretory Therap...
...cid suppression is the mainstay th...
...ide the most rapid symptomatic relief and h...
...less effective than PPIs*, HRAs give...
...therapy is recommended for patients...
...motility AgentsPromotility agents may be...
...n of TreatmentBecause GERD is a chronic condition...
...ted Reflux Chest Pain SyndromeTwice-daily...
...spected Extraesophageal Reflux Syndrom...
...enance therapy with twice-daily PPIs* is recommend...
...ractory to medical therapy is not common. Furth...
...s for Antireflux Surgery...
...resently, endoscopic therapy has no role in...
...rgery, performed by an experienced surgeon, is rec...
GERD responsive to acid suppressive...
...surgery is not recommended as an ant...
Table 1. Treatment Regimens for GERD
...1. Treatment Regimens for GERD Havin...