Update on GERD management
The American College of Gastroenterology recommends Patients with heartburn and regurgitation but no other symptoms should take a proton pump inhibitor once daily for 8 weeks. Gastroesophageal reflux (GERD) is diagnosed by a favourable clinical response to proton pump inhibitors (PPIs).
PPIs should be taken 30-60 minutes before a meal since they bind to proton pumps those meals stimulate. Relapsed PPI responders and PPI nonresponders should be examined for GERD. Endoscopy 2–4 weeks post-PPI (to maximise the chance to document esophagitis). The next phase is ambulatory pH monitoring (off therapy).
The authors advise individuals with no history of high-grade esophagitis or Barrett's oesophagus to use intermittent or "on-demand" PPI medication. Patients who need PPI medication should take the lowest effective dosage. While there are statistical links between long-term PPI medication and some "complications," the causality of most of these is questionable.
Although the evidence for beneficial diet and lifestyle changes for GERD is minimal, the authors advocate weight loss, quitting smoking, and avoiding eating before night. Elevating the bed's head or lying on a wedge and sleeping on the left side are also advised.
With no warning signs and satisfactory response to a PPI, primary care doctors generally restart PPI medication without additional review. Patients with erosive esophagitis or Barret esophagitis should undergo endoscopy to rule out other causes of erosive esophagitis (e.g., eosinophilic esophagitis).
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