GERD
GERD is diagnosed and managed per the American College of Gastroenterology 2022 clinical guideline, which centers on an empiric proton pump inhibitor trial for classic symptoms without alarm features.
Symptoms
Heartburn and regurgitation are typical; chronic cough, hoarseness, or throat clearing can be atypical (extraesophageal) presentations that are less reliably tied to reflux.
Causes and risk
A weak lower esophageal sphincter, hiatal hernia, obesity, pregnancy, smoking, and certain foods all contribute.
How it is evaluated
An 8-week once-daily PPI trial is the standard first step for classic symptoms without alarm features. Endoscopy is reserved for alarm symptoms, non-response or symptom recurrence after the PPI trial, Barrett's esophagus risk factors, or unexplained chest pain.
Treatment
PPIs are dosed 30-60 minutes before meals, with an attempt at discontinuation once symptoms resolve for milder disease -- on-demand or H2-blocker step-down is appropriate there. Long-term PPI maintenance is only mandatory for more severe esophagitis (LA grade C/D) or Barrett's esophagus. Lifestyle measures with real evidence behind them: weight loss, avoiding meals within 2-3 hours of bedtime, head-of-bed elevation, and avoiding tobacco and personal trigger foods.
When to seek care
Chest pain should always be evaluated for a cardiac cause before being attributed to reflux. Difficulty swallowing, unintended weight loss, GI bleeding, or persistent vomiting are alarm symptoms that need prompt endoscopic evaluation.