GERD Algorithm

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Source: Institute for Clinical Systems Improvement (ICSI). Initial management of dyspepsia and GERD. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2006 Jul. 53 p. GERD Algorithm Alarm features: *Melena. *Persistent vomiting. *Dysphagia. *Hematemesis. *Anemia. *Weight loss greater than 5% (involuntary). Symptoms of GERD. A Are there alarm features? A Endoscopy for alarm features/out of guideline. A Initial management: (8 weeks) *PPI/antacids. *Encourage behavioral modification. *Consider endoscopy of patient greater than or equal to 50 and symptoms greater than or equal to 10 years. A Symptom relief? Endoscopy. A Encourage single trial step-down therapy. A Positive? A Case management for negative endoscopy. A Continue step-down therapy Symptoms recur? Case management for refractory reflux. A Return to chronic PPI therapy. A A = Annotation All copyrights are reserved by the Institute for Clinical Systems Improvement, Inc.