Management algorithm of GERD patient who failed PPI once daily

Management algorithm of gastroesophageal reflux disease (GERD) patient who failed PPI once daily (complete or partial*).

PPI: proton pump inhibitor; SSRIs: selective serotonin reuptake inhibitors; SNRIs: serotonin-norepinephrine reuptake inhibitors; TLESR: transient lower esophageal sphincter relaxation; H2RA: histamine 2 receptor antagonist.
* Partial or incomplete relief of symptoms.

Original figure modified for this publication. Hershcovici T, Fass R. An algorithm for diagnosis and treatment of refractory GERD. Best Pract Res Clin Gastroenterol 2010; 24:923. Illustration used with the permission of Elsevier Inc. All rights reserved.

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Management algorithm of GERD patient who failed PPI once daily