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

...ssessment

...agnostic Test...

...biopsy is recommended in patients with GERD...

...ndoscopy in subjects with erosive or nonerosive r...

...nometry is recommended to evaluate GERD patients w...

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

...igure 1. Patient With GERD-Rela...


Management

Management

...estyle Modificati...

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

...levation of the head of the bed, avoiding recumb...


...ent Directed Therapy...

...ids and over-the-counter (OTC) acid suppressants...

...hen symptoms persist, continuous therapy with H2...

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


...secretory Therapies...

...on is the mainstay therapy for GERD. (I)415...

...ovide the most rapid symptomatic relie...

...ess effective than PPIs*, HRAs give...

...PI* therapy is recommended for patients with...


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


...ion of TreatmentBecause GERD is a chronic conditi...


...spected Reflux Chest Pain SyndromeTwice-daily P...


...ted Extraesophageal Reflux Syndrome...

...enance therapy with twice-daily PP...

...refractory to medical therapy is not...


...ons for Antireflux Surgery...

..., endoscopic therapy has no role in G...

Antireflux surgery, performed by an exp...

...to acid suppressive therapy. (II)Rema...

...rgery is not recommended as an antine...


Table 1. Treatment Regimens for GERD 

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