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Gastroenterology
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GERD Management
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PPI trial vs endoscopy depending on alarm features.
Decision
Outcome
Decision
GERD-typical symptoms. Alarm features or men >50 with >5 y symptoms?
✓
No → empiric once-daily PPI for 2 months + lifestyle measures
✓
Yes → endoscopy
Decision
After 2 months — refractory?
✓
No → continue therapy at lowest effective dose
✓
Yes → switch PPI or increase to BID dosing
Outcome
Continue PPI at the lowest effective dose; address weight loss, head-of-bed elevation, evening eating
Decision
After PPI escalation — controlled?
✓
Yes → continue at the effective dose
✓
No → endoscopy + pH monitoring
Outcome
Test for achalasia, gastroparesis, non-acid reflux, nocturnal acid breakthrough
Decision
Endoscopy result?
✓
Esophagitis → treat per finding
✓
No esophagitis → consider pH monitoring, manometry, or alternative diagnoses
Outcome
Treat: pill esophagitis, eosinophilic, Barrett, autoimmune, ZES, scleroderma per finding
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