General Approach to Treatment

® Treatment for GERD involves one or more of the following modalities: (a) lifestyle changes and patient-directed therapy; (b) pharmacologic intervention primarily with acid-suppressing agents; (c) antireflux surgery; or (d) endoscopic therapies. The first therapeutic option used depends upon the patient's condition (i.e., frequency of symptoms, degree of esophagitis, and presence of complications; Table 17-2).

^ Acid-suppressing therapy is the mainstay of GERD treatment and should be considered for anyone not responding to patient-specific lifestyle changes and patient-directed therapy after 2 weeks. The PPIs provide the greatest relief of symptoms and highest rates of healing, especially in patients with erosive disease or moderate to severe symptoms.

Maintenance therapy is generally necessary to control symptoms and prevent complications. GERD that is refractory to adequate acid suppression is rare. In these cases, the diagnosis should be confirmed through further diagnostic tests before long-term, high-dose therapy or antireflux surgery or endoscopic therapies are considered.1

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