GERD: Beyond Proton Pump Inhibitors

Diagnostic Evaluation

Typical symptoms (heartburn, regurgitation) often suffice for diagnosis. Alarm symptoms (dysphagia, weight loss) warrant endoscopy. Ambulatory pH monitoring helps evaluate refractory cases or atypical presentations.

Lifestyle Modifications

Weight loss significantly improves symptoms. Elevating head of bed and avoiding late meals reduce nocturnal reflux. Dietary triggers vary but commonly include caffeine, alcohol, and fatty foods.

Medical Management

PPIs remain first-line but should be used at lowest effective dose. H2 blockers may help nocturnal breakthrough. Alginate formulations provide on-demand relief. Potassium-competitive acid blockers offer new options.

Endoscopic and Surgical Options

Refractory cases may benefit from LINX device or fundoplication. Newer endoscopic treatments like Stretta show promise. Careful patient selection is crucial for procedural interventions.

Long-term Considerations

Chronic PPI use requires periodic reevaluation. Barrett's esophagus needs surveillance. Emerging data guides management of extraesophageal manifestations like chronic cough.