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
- persistent reflux after trial of PPI
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)