Chronic GERD: What’s Your Next Step?

GERD of long-standing duration may require on-demand PPI dosing-and evaluation for esophageal damage.

A 58-year-old obese man presents to your clinic for follow-up of GERD. He has had reflux symptoms, characterized by heartburn and regurgitation, for more than 20 years. His reflux worsens when he is supine. His symptoms are generally well-controlled with once-daily PPI dosing, but he occasionally requires an on-demand second dose. Which of the following strategies would you recommend?

A. Refer for upper endoscopy to screen for Barrett esophagus
B. Refer for barium swallow to document GERD
C. Confirm presence of GERD with 24-hour pH study
D. Continue PPI therapy indefinitely and refer only if symptoms change

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