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

Assessme...

...gnostic Tests...

...with biopsy is recommended in patients wit...

...ndoscopy in subjects with erosive or...

...recommended to evaluate GERD patients who a...

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

...ure 1. Patient With GERD-Related Sympt...


Management

Management

...estyle Modificati...

...ht loss should be advised for overweight or obes...

...ation of the head of the bed, avoiding...


...t Directed Therap...

Antacids and over-the-counter (OTC)...

...s persist, continuous therapy with H2RA...

...oms or signs develop, the patient should be eva...


...isecretory Therapi...

...suppression is the mainstay therapy fo...

...e the most rapid symptomatic relief and healing o...

...effective than PPIs*, HRAs given in divide...

...ly PPI* therapy is recommended for pat...


...ty AgentsPromotility agents may be us...


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


...flux Chest Pain SyndromeTwice-daily PPI* therapy...


...d Extraesophageal Reflux Syn...

...intenance therapy with twice-daily PPIs* is recomm...

...refractory to medical therapy is no...


...cations for Antireflux Surgery...

..., endoscopic therapy has no role in GERD treatment...

...reflux surgery, performed by an experienced sur...

...onsive to acid suppressive therapy. (II)Re...

...surgery is not recommended as an antin...


Table 1. Treatment Regimens for GERD 

...tment Regimens for GERD Having trouble vie...