Diagnosis of gastroesophageal reflux disease (GERD) is clinical. The classic symptoms are heartburn and regurgitation. A therapeutic trial of a proton-pump inhibitor (PPI) can serve for both diagnosis and initial treatment.
Upper endoscopy is indicated to evaluate for complications; for atypical, persistent, or relapsing symptoms; or for alarm features (e.g., weight loss, anemia).
High rate of relapse upon stopping treatment.
Serious complications of GERD include stricture, Barrett esophagus, or esophageal carcinoma.
Typical symptoms are heartburn and acid regurgitation. Extraesophageal symptoms include cough, laryngitis, asthma, or dental erosion. Atypical symptoms include dyspepsia, epigastric pain, nausea, bloating, and belching.
GERD may occur with or without esophageal inflammation (esophagitis). If erosions are present on endoscopic examination, the condition is called erosive reflux disease (ERD); if there are no erosions, it is called nonerosive reflux disease (NERD).
History and exam
Key diagnostic factors
- acid regurgitation
Other diagnostic factors
- bloating/early satiety
- enamel erosion
- family history of heartburn or GERD
- older age
- hiatal hernia
- lower esophageal sphincter (LES) tone-reducing drugs
- psychological stress
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- alcohol consumption
- peroral endoscopic myotomy (POEM)
- dietary factors
1st investigations to order
- proton-pump inhibitor trial
Investigations to consider
- esophagogastroduodenoscopy (EGD)
- ambulatory pH monitoring
- esophageal manometry
- combined impedance-pH testing
- barium swallow
- esophageal capsule endoscopy
- endolumenal functional lumen imaging probe
incomplete response to proton-pump inhibitor
- Acute coronary syndrome
- Stable angina
- Functional esophageal disorder/functional heartburn
- American Society for Gastrointestinal Endoscopy guideline on informed consent for GI endoscopic procedures
- AGA clinical practice update on de-prescribing of proton pump inhibitors: expert review
GERD: questions to ask your doctorMore Patient leaflets
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