Slides

Considerable uncertainty remains about how to achieve the goals of GERD therapy. For patients treated empirically, standard treatment often involves an 8-week trial of PPIs, along with lifestyle modification (e.g., weight loss, limiting tobacco and alcohol). For those who respond and are not at high risk of an adverse outcome, step down to either continuous or as-needed H2RAs is sometimes used. Depending on the severity of symptoms and clinical response, prescription or over-the-counter medications, especially H2RAs and PPIs, may be used intermittently (on-demand), periodically, or continuously. Antireflux surgery (fundoplication) aims to correct gastroesophageal reflux by reducing a hiatal hernia, reconstructing the esophageal hiatus, and reinforcing the lower esophageal sphincter. Some patients with insufficient response to medication may improve with surgery. Surgery is typically only performed in very carefully evaluated patients whose disease is refractory to medicine, as some are not good candidates for surgery. Moreover, some patients whose disease is responsive to medication may consider surgery for certain reasons. There is no consensus about which patients are optimal surgical candidates. Endoscopic treatments have recently become available and are currently being studied, but they are mostly reserved for use in clinical trials because efficacy data are very limited.

Abbreviations:

GERD = gastroesophageal reflux disease
H2RA = histamine type 2 receptor antagonist
PPI = proton pump inhibitor