Initial management of gastroesophageal reflux disease in adults with pretreatment endoscopy

This algorithm shows the initial management of adults with reflux-like symptoms who have undergone endoscopy prior to treatment. Upper endoscopy is indicated to evaluate alarm features, screen for Barrett's esophagus in those with risk factors, or follow up abnormal imaging. Refer to UpToDate content on the medical management of GERD for details.

GERD: gastroesophageal reflux disease; LA: Los Angeles; PPI: proton pump inhibitor.

* Individuals with LA grade A esophagitis are managed the same as those without esophagitis.

¶ Identify symptom triggers (eg, nocturnal symptoms, large meals, alcohol, soda intake, tobacco use, or specific foods), and individualize lifestyle changes to address them.

Δ Standard-dose PPI options include once-daily dexlansoprazole 30 mg, esomeprazole 40 mg, lansoprazole 30 mg, omeprazole 20 mg, pantoprazole 40 mg, and rabeprazole 20 mg.

◊ Standard-dose vonoprazan is preferred, especially for patients with LA grade C to D esophagitis, because it may heal erosive esophagitis more rapidly and effectively. PPIs are an acceptable alternative.

§ Refer to UpToDate content for details regarding tapering and discontinuing PPIs or vonoprazan.

¥ For patients with recurrent symptoms, reinforce lifestyle changes and treat with course of previously effective GERD medication (eg, PPI for 8 weeks). Patients whose symptoms recur <3 months after discontinuing PPI or vonoprazan may require maintenance acid suppression.

Graphic 145886 Version 3.0

خرید پکیج

Initial management of gastroesophageal reflux disease in adults with pretreatment endoscopy