Investigations & Treatment of GERD

Diagnosis

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.

endoscopy

Indication:

• 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.

Treatment 

Conservative

• 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)

Pharmacological

• 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

Surgery

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

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