GERD

Identify typical symptoms, rule out alarm features, and initiate therapy.

Last reviewed January 5, 2026

Red flags

Dysphagia, odynophagia, GI bleeding, or unexplained weight loss.
Persistent vomiting or iron-deficiency anemia.

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.

Referral triggers

Alarm features or failure to respond to optimized PPI therapy.
Suspected Barrett's esophagus or recurrent strictures.

References

ACG guideline for GERD diagnosis and management (2022) (opens in a new tab)

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