Management
Lifestyle Modifications (IV) ÎWeight loss should be advised for overweight or obese patients with esophageal GERD symptoms.
ÎAdvise elevation of the head of the bed, avoiding recumbency for 3 hours before bedtime, avoiding late meals and specific foods (fat, chocolate, alcohol, peppermint, coffee, onions and garlic) and smoking cessation— tailored to the circumstances of the individual patient.
Patient Directed Therapy (IV) ÎAntacids and over-the-counter (OTC) acid suppressants are options for patient-directed therapy for post-prandial heartburn and regurgitation.
ÎWhen symptoms persist, continuous therapy with H2RA or PPI* is required. ÎWhen alarm symptoms or signs develop, the patient should be evaluated by endoscopy.
Antisecretory Therapies (I) ÎAcid suppression is the mainstay therapy for GERD.
ÎPPIs* provide the most rapid symptomatic relief and healing of erosive esophagitis in the highest percentage of GERD patients.
ÎAlthough less effective than PPIs*, H2RAs given in divided doses may be effective in some patients with less severe GERD.
ÎTwice-daily PPI* therapy is recommended for patients with atypical or extra-esophageal manifestations of GERD.
Promotility Agents (II) ÎPromotility agents may be used in selected patients, especially those with delayed gastric emptying. Currently available promotility agents are not ideal monotherapy for most patients with GERD.
Duration of Treatment (I) ÎBecause GERD is a chronic condition, continuous therapy to control symptoms and prevent relapse or complications is appropriate.
ÎTitrate to the lowest effective dose based on symptom control.
Suspected Reflux Chest Pain Syndrome ÎTwice-daily PPI* therapy is recommended as an empirical trial for patients with suspected reflux chest pain syndrome after a cardiac etiology has been carefully considered.
Suspected Extraesophageal Reflux Syndromes
ÎAcute and maintenance therapy with twice-daily PPIs* is recommended for patients with suspected atypical/extraesophageal GERD manifestations (cough, laryngitis, asthma).
ÎGERD that is refractory to medical therapy is not common. Further evaluation with esophageal impedance + pH is helpful to stratify patient populations for further treatment.
