Control of chronic GERD is essential because it is associated with Barrett's esophagus in older patients. Clinicians should first advise patients to undertake lifestyle changes, including elevating the head of the bed by 8 in, avoiding large meals, and waiting 3 hours after a meal before lying down. Dietary changes include abstention from chocolate, alcohol, coffee, carbonated beverages, citrus juice, and tomato-based products.
Although PPIs are an important treatment option, they are reserved for patients in whom GERD has been documented with objective assessment. Histamine 2–receptor antagonists are the preferred first-line agents in patients with mild to moderate GERD symptoms and grades I-II esophagitis.
The most common surgery for GERD in both children and adults is the laparoscopic Nissen fundoplication. Patients with symptoms that are not completely controlled by PPI therapy can be considered for surgery; surgery can also be considered in patients with well-controlled GERD who desire a definitive, one-time treatment. The presence of extraesophageal manifestations of GERD may indicate the need for surgery; these include: (1) respiratory manifestations (eg, cough, wheezing, aspiration); (2) ear, nose, and throat manifestations (eg, hoarseness, sore throat, otitis media); and (3) dental manifestations (eg, enamel erosion).
Other indications for fundoplication include:
Cardiac conduction defects
Poor patient compliance with regard to medications
Osteoporosis in postmenopausal women
Learn more about GERD treatment.
This Fast Five Quiz was excerpted and adapted from the Medscape articles Gastroesophageal Reflux Disease, Gastroesophageal Reflux Disease (GERD) Imaging, and Laparoscopic Nissen Fundoplication.
Follow Medscape on Facebook, Twitter, Instagram, and YouTube
Lead image: Medicalartinc/Dreamstime
Medscape © 2023 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: B.S. Anand. Fast Five Quiz: Gastroesophageal Reflux Disease Practice Essentials - Medscape - Feb 06, 2023.