Investigations & Treatment of GERD


It is based on patient symptoms.

24 Hour pH Monitoring

If diagnosis is unclear and PPI are not responding, 24h pH monitoring can be done.



  • Dysphagia, odynophagia
  • Heartburn with weight loss or bleeding
  • Anemia
  • persistent reflux after trial of PPI

esophageal manometry

diagnosis of abnormal peristalsis or decreased LES tone.



  • Life Style changes: Elevating the head of the bed at night, lose weight if Obese
  • Diet and habits: Avoid smoking, alcohol, nicotine, coffee, spices, chocolate, peppermint, tomatoes and acidic juices
  • Avoid taking foods before sleep (eat at least 3 hours before bed)


  • Simple antacids: magnesium trisilicate and aluminium hydroxide, Alginate
  • H2-receptor antagonists: cimetidine, ranitidine, famotidine
  • Proton Pump Inhibitor (PPI): These are most effective. When the symptoms are persistent and erosive esophagitis. omeprazole, esomeprazole, lansoprazole, pantoprazole
  • a lower dose (10 mg) of PPI can be used as maintenance therapy.
  • To increase the gastric emptying and GI motility: Domperidone


When medical therapy is not responsive, surgical procedure may require to tighten the LES.

  • Nissen Fundoplication: stomach is wrapped around the lower esophagus (LES)