Treatment gastroesophageal reflux disease

(World J Gastrointest Endosc 2018;10:175; Am J Gastro 2022;117:27)

• Lifestyle:

  • avoid precipitants,
  • lose weight,
  • no eating 2 hrs before bed,
  • exercise,
  • Ø tobacco

• Medical:

  • start low-dose PPI,
  • uptitrate up to 40 mg bid;
  • H2 blockers for intermittent sx

• Refractory (max dose ≥8 wks): confirm w/ pH testing on or off PPI, consider hernia repair

  • Ambulatory pH impedance monitoring

• If acidic or sx correlate w/ reflux episodes:

  • surgical fundoplication (emerging Rx: LES sphincter augmentation w/ radiofrequency, implantable magnetic or electrical devices)

• If nl pH or no sx correlation = fxnal dyspepsia (Gastro 2020;158:2286);

  • Rx w/ TCA, SSRI