Gastroesophageal Reflux Disease (GERD)- Management

Gastroesophageal Reflux Disease (GERD)- Management

Definition

Gastroesophageal Reflux Disease (GERD) is a disorder resulting from reflux of gastric acid, pepsin, and other gastric contents into the esophagus due to incompetence of the gastroesophageal junction barrier. The condition leads to active inflammation of the distal third of the esophagus. Prolonged exposure to gastric acid may result in esophageal stricture formation.

Clinical presentation

Typical Symptoms

• Heartburn

• Regurgitation

Associated symptoms

• Odynophagia

• Dysphagia

• Weight loss

• Gastrointestinal bleeding

Extra-esophageal manifestations

• Chronic cough

• Laryngitis

• Pharyngitis

• Chronic bronchitis

• Asthma

• Chronic obstructive pulmonary disease (COPD)

• Pneumonia

• Chronic sinusitis

• Dental decay

Investigations

Endoscopy

• Evidence of esophageal mucosal ulceration

Histology

• Evidence of chronic active inflammation

Esophageal pH Monitoring

• Positive 24-hour esophageal pH study (gold standard investigation)

Pharmacological treatment

Non-Erosive Symptomatic GERD

Omeprazole

• Dose: 20 mg

• Route: Oral (PO)

• Frequency: Every 24 hours

• Duration: 8 weeks

OR

Esomeprazole

• Dose: 20–40 mg

• Route: Oral (PO)

• Frequency: Every 24 hours

• Duration: 8 weeks

Erosive Esophagitis

Pantoprazole

• Dose: 40 mg

• Route: Oral (PO)

• Frequency: Every 24 hours

• Duration: 8–16 weeks

Refractory GERD

• Acid suppression therapy may need to be continued for up to 6 months in refractory cases.

Lifestyle modifications

• Avoid smoking

• Avoid alcohol consumption

• Avoid NSAID use

• Avoid known symptom triggers

Referral

Refer patients to a higher-level centre with appropriate expertise and facilities if they have:

• Refractory symptoms despite treatment

• Gastrointestinal bleeding

• Anaemia

• Early satiety

• Progressive dysphagia

• Progressive odynophagia

• Unexplained weight loss

• Recurrent vomiting

• Family history of gastrointestinal cancers

• Age ≥ 40 years with concerning symptoms

Monitoring

• Improvement in heartburn

• Improvement in regurgitation

• Resolution of dysphagia or odynophagia

• Response to proton pump inhibitor therapy

• Development of alarm symptoms

Possible complications

• Chronic esophagitis

• Esophageal ulceration

• Esophageal stricture

• Gastrointestinal bleeding

• Aspiration-related respiratory disease

• Recurrent pulmonary infections

Follow-up

• Reassess symptoms after completion of therapy.

• Evaluate adherence to lifestyle modifications.

• Refer patients with persistent symptoms or alarm features for specialist assessment and endoscopic evaluation.