Diagnosis and treatment of gastroesophageal reflux disease

Table 1 Symptoms of gastroesophageal reflux disease

Typical Symptoms	Acid regurgitation, heartburn
Atypical Symptoms	Epigastric fullness, epigastric pressure, epigastric pain, dyspepsia, nausea, bloating, belching
Extraesophageal Symptoms	Chronic cough, bronchospasm, wheezing, hoarseness, sore throat, asthma, laryngitis, dental erosions

Table 2 Diagnostic Testing for gastroesophageal reflux disease

Diagnostic test	Indication
PPI trial	Classic GERD symptoms with no alarm symptoms.
Esophageal pH monitoring	Refractory symptoms where GERD diagnosis is in question, pre-operative evaluation for non-erosive disease
Upper endoscopy	Alarm symptoms (e.g., dysphagia), PPI unresponsive patients, high risk for Barrett’s esophagus
Barium esophagram	Evaluation of dysphagia, otherwise not recommended for GERD evaluation
Esophageal manometry	Prior to anti-reflux surgery to rule out esophageal dysmotility (e.g., achalasia, scleroderma), otherwise not recommended for GERD evaluation

GERD: Gastroesophageal reflux disease; PPI: Proton pump inhibitor.

Table 3 Indications for anti-reflux surgery

Unwillingness to remain on lifelong medical therapy

Intolerance of medical therapy

Medically refractory symptoms with objective evidence of GERD

GERD in the setting of a large hiatal hernia

Medically refractory GERD in the setting of morbid obesity

GERD: Gastroesophageal reflux disease.