Management of GERD

Diagnosis of GERD is mainly CLINICAL, and once it's clinically suspected it's treated directly, no need for investigations unless the diagnosis is equivocal,

 

The most specific test for GERD is 24 hours esophageal pH manometry test, which is rarely performed.

Endoscopy may be associated with esophageal inflammation, or may be normal; a normal endoscopy DOESN'T exclude GERD.

Endoscopy is ONLY performed in the following conditions:

1- Loss of weight

2- Anemia/Heme positive stools

3- Dysphagia

4- Persistence of symptoms for more than 5 years to exclude anatomical abnormalities as Barett's esophagus.

INTERMITTENT Reflux is treated by Antacids and H2 blockers.

PERSISTENT Reflux is treated through Proton Pump Inhibitors.

If GERD symptoms didn't improve upon with medical treatment, surgical intervention may be scheduled:

1- Nissen Fundoplication: wrapping the stomach around the LES

2- Endoninch: suturing around the LES guided by endoscopy

3- Heat/Laser irradiation to induce scar.