Conditions
GERD
Identify typical symptoms, rule out alarm features, and initiate therapy.
Last reviewed 2026-01-05|gi | reflux | chronic
Diagnosis
- Typical symptoms include heartburn and regurgitation without alarm features.
- Consider a diagnostic PPI trial for uncomplicated presentations.
Initial workup
- Review medications (NSAIDs, calcium channel blockers) and lifestyle triggers.
- Test for H. pylori if dyspepsia symptoms are prominent.
First-line management
- Lifestyle: weight loss, avoid late meals, elevate head of bed, reduce trigger foods.
- Start a PPI once daily for 4-8 weeks, then step down if controlled.
Red flags
- Dysphagia, odynophagia, GI bleeding, or unexplained weight loss.
- Persistent vomiting or iron-deficiency anemia.
Referral triggers
- Alarm features or failure to respond to optimized PPI therapy.
- Suspected Barrett's esophagus or recurrent strictures.