Primary care Doctors treat most patients empirically with the strongest medication that they have been detailed about, and they are often not sure when to refer patients with GERD to specialist or when to stop or modify treatment. GERD can present itself in a variety of ways from esophageal to supra and peri-esophageal syndromes. Not all endoscopist report the degree of damage that they see in a systematic way. This grading is very important and should be adopted by endoscopists. When heartburn, the most common presenting symptom, is present no further diagnostic testing is necessary before initiating empirical therapy for symptomatic relief.
Recent studies suggest that proton pump inhibitors are the preferred form of medical therapy.
In addition to symptomatic relief of heartburn, they heal esophageal mucosal injury and reduce the need for frequent dilatation in patients with peptic stricture. Occasionally, as in chest pain, chronic cough, asthma or dyspepsia due to GERD, therapeutic trials of PPIs may be our only diagnostic as well as therapeutic tool. Unfortunately, if treatment is stopped symptoms will return. Laparoscopic Nissen's Fundoplication must be reserved for patients that are surgical candidates and have responded favorably to the therapeutic dose of PPIs for their given condition. M.Farivar M.D. The information provided is the author's opinion based on years of clinical experience and research.