By rray, 23 December, 2014 If alarm sx (eg, dysphagia) or high risk of GERD complications: endoscopy<sup>16</sup> recommended
By rray, 23 December, 2014 If extra-esophageal sx persist despite PPI optimization: concomitant evaluation by ENT, pulmonary, and allergy specialists [S/L]; if refractory after these evals negative: ambulatory reflux<sup>17</sup> monitoring [S/L]
By rray, 23 December, 2014 If typical/dyspeptic sx PPI-refractory: upper endoscopy<sup>16</sup> to r/o non-GERD etiologies [C/L]; if endoscopy negative: ambulatory reflux<sup>17</sup> monitoring [S/L]; if tests negative: unlikely to have GERD, so discontinue PPI [S/L]
By rray, 23 December, 2014 If alarm sx (eg, dysphagia) or high risk of GERD complications: endoscopy<sup>14</sup> recommended
By rray, 23 December, 2014 Ambulatory reflux monitoring is the only test that can assess reflux-to-symptom association [S/L]
By rray, 23 December, 2014 Reflux monitoring off meds can be performed by either pH or impedance-pH [C/M]. Testing on meds should be performed w/ impedance-pH monitoring [S/M].
By rray, 23 December, 2014 After r/o cardiac cause: pts w/ noncardiac chest pain should have diagnostic eval before instituting tx [C/M]; consider dx eval w/ endoscopy<sup>12</sup> + pH monitoring, before a PPI trial.<sup>13</sup>