GERD

# GERD
Reflux or retrosternal burning sensation worse with eating or when lying flat.
DDx: dyspepsia (epigastric discomfort, gas, nausea), esophagitis, stricture, adenocarcinoma
Complicatons: barret esophagus, stricutres, esophagitis, adenocarcinoma.
Worrisome: bleeding, odynophagia, dysphagia, anorexia, weight loss, and signs of systemic illness, unexplained IDA, should prompt referral.
- PPI, lowest effective dose,
- long term PPI for barrett's, bleeding ulcer
- consider H. pylori testing
- consider esophageal pH/impedance monitoring, GERD vs functional syndrome.
- Get endoscopy if uncontrolled on BID PPI or if male with > 5y GERD and any two of: age>50; Caucasian; central obesity (waist >102cm); current/former smoker; +FH of Barrett's esophagus or esophageal adenocarcinoma.
- long term control: limit soda, chocolate, coffee, citrus, onions, tomatos, high-fat, spicy, overeating, EtOH, smoking, medications (antiACh, SSRIs, TCAs, benzo, BB, CCB, NSAIDs, nitrates, sildenafil, bisphosphonates, prostaglandins)