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>
By rray, 23 December, 2014 For typical GERD sx nonresponsive to PPI: endoscopy<sup>9</sup> to exclude non-GERD etiologies [C/L]
By rray, 23 December, 2014 If refractory GERD after these evals negative: ambulatory reflux<sup>8,11</sup> monitoring [S/L]
By rray, 23 December, 2014 Concomitant evaluation by ENT, pulmonary, and allergy specialists<sup>9</sup> [S/L]