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<sup>1</sup> A negative PPI trial does not r/o GERD.<br><br><sup>2</sup> PPI once-daily dosing, before 1st meal of day [S/M]. <br><br>
<sup>3</sup> Upper endoscopy not required for typical GERD sx [S/M]. Consider endoscopy early for elderly, pts at risk for Barrett’s, noncardiac chest pain, and pts unresponsive to PPI. Consider screening for Barrett’s in high-risk pts (long GERD duration, age >50 yo, male, Caucasian) [C/M]. Routine distal esophagus bx not recommended specifically to dx GERD [S/M]. <br><br>
<sup>4</sup> Ambulatory esophageal reflux monitoring indicated in situations when GERD dx is in question [S/L]; it’s the only test that can assess reflux-to-symptom association [S/L]. <br><br>
<sup>5</sup> Use barium swallow for eval of dysphagia or GERD complication (stricture, ring).
<sup>3</sup> Upper endoscopy not required for typical GERD sx [S/M]. Consider endoscopy early for elderly, pts at risk for Barrett’s, noncardiac chest pain, and pts unresponsive to PPI. Consider screening for Barrett’s in high-risk pts (long GERD duration, age >50 yo, male, Caucasian) [C/M]. Routine distal esophagus bx not recommended specifically to dx GERD [S/M]. <br><br>
<sup>4</sup> Ambulatory esophageal reflux monitoring indicated in situations when GERD dx is in question [S/L]; it’s the only test that can assess reflux-to-symptom association [S/L]. <br><br>
<sup>5</sup> Use barium swallow for eval of dysphagia or GERD complication (stricture, ring).
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