Diagnosis of GERD

The Acid Reflux Strategy

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The most useful tool in the diagnosis of GERD is the clinical history, including both the presenting symptoms and associated risk factors. Patients presenting with uncomplicated, typical symptoms of reflux (heartburn and regurgitation) do not usually require invasive esophageal evaluation. These patients generally benefit from a trial of patient-specific lifestyle modifications and empiric acid-suppressing therapy.1 A clinical diagnosis of GERD is assumed in those responding to appropriate therapy.

Endoscopy with biopsy is the preferred diagnostic test for assessing the mucosa for esophagitis and Barrett's esophagus. It should also be performed in patients with troublesome dysphagia, weight loss, or epigastric mass and in patients with esopha-

geal GERD syndrome who have not responded to an empiric trial of twice-daily pro-

ton pump inhibitor (PPI) therapy. While controversial, some feel that screening for Barrett's esophagus should be performed in patients more than 50 years of age and those with longstanding heartburn.

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FIGURE 17-2. Therapeutic interventions in the management of gastroesophageal reflux disease. Pharmacologic interventions are targeted at improving defense mechanisms or decreasing aggressive factors. LES, lower esophageal sphincter. (Adapted with permission from Williams DB, Schade RR. Gastroesophageal reflux disease. In: DiPiro JT, Talbert RL, Yee GC, et al., eds. Pharmacotherapy: A Pathophysiologic Approach, 7th ed. New York: McGraw-Hill 2008: 559.)

FIGURE 17-2. Therapeutic interventions in the management of gastroesophageal reflux disease. Pharmacologic interventions are targeted at improving defense mechanisms or decreasing aggressive factors. LES, lower esophageal sphincter. (Adapted with permission from Williams DB, Schade RR. Gastroesophageal reflux disease. In: DiPiro JT, Talbert RL, Yee GC, et al., eds. Pharmacotherapy: A Pathophysiologic Approach, 7th ed. New York: McGraw-Hill 2008: 559.)

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