Symptoms worsen with reclining. Atypical symptoms include wheezing, hoarseness, chest pains, chronic cough, earache, recurrent aspiration, and sore throat. Conduct an esophageal manometry when antireflux surgery is planned for patients with recurrent dysphagia with normal endoscopy. Check serum gastrin levels to rule out Zollinger-Ellison syndrome, for secretory analysis, or for patients unresponsive to treatment steps 1 through 4. Barium esophagography is sometimes used for patients with severe dysphagia to identify strictures prior to endoscopy.
Lifestyle modification is the cornerstone of management.
The management goals are to improve esophageal and gastric motility, increase basal LES tone, and lower the acidity of the refluxate. Eat multiple small meals. Nissen fundoplication commonly performed via laparoscopy.