GERD (Gastroesophageal reflux disease) is one of the most often seen complaints among general practitioners. Recently, the ACG modified its GERD recommendations to encompass pharmaceutical, lifestyle, surgical, and endoscopic treatment options. The American Journal of Gastroenterology published the revisions. Listed in this article are the updated GERD diagnostic and treatment recommendations.

The revised GERD guidelines' goal is to synthesise the most up-to-date, but practical, suggestions for the diagnosis and care of individuals with GERD. They have been established to assist clinicians in providing the best evidence-based patient care possible, using the full range of diagnostic tests and treatment options available for these often complicated patients. These tips are quite beneficial in daily practice. Among the guidelines for diagnosis and treatment are the following:

1. An eight-week trial of empiric proton pump inhibitors administered once daily before a meal is advised in individuals with heartburn and regurgitation who do not exhibit worrisome symptoms. If patients react well to the eight-week study, doctors should consider tapering off PPIs.
2. Following a 2 to 4 week discontinuation of PPIs, diagnostic endoscopy should be done in patients with typical GERD symptoms who do not react adequately to an 8-week trial of empiric PPIs.
3. Objective GERD testing (endoscopy and/or reflux monitoring) is advised in people who have chest discomfort without experiencing heartburn and have not been evaluated for heart disease.
4. The use of a barium swallow alone as a diagnostic test for GERD is not suggested.
5. Endoscopy is the first test that should be performed on individuals who come with dysphagia or other frightening symptoms, as well as on patients who have risk factors for Barrett's oesophagus.
6. Reflux monitoring should be used as an adjunct to endoscopy in individuals with suspected GERD but no evidence of GERD on endoscopy. However, in individuals with endoscopic evidence of Los Angeles (LA) grade C or D reflux esophagitis or those with long-segment Barrett's oesophagus, reflux monitoring off treatment should not be used alone as a diagnostic test for GERD.
7. In individuals who are overweight or obese, weight reduction is indicated to alleviate GERD symptoms.
8. Avoid eating meals within two to three hours of sleep.
9. Tobacco products should be avoided, as should smoking.
10. Avoid "trigger foods" for GERD symptoms.
11. Patients should raise their heads of beds at night to relieve GERD symptoms.
12. PPIs, rather than histamine-2-receptor antagonists, should be utilised to treat EE. Patients with GERD but not EE or Barrett's oesophagus should seek to quit PPIs or transition to on-demand treatment and take PPIs only when symptoms arise.
13. For GERD symptoms, PPIs should be taken 30 to 60 minutes before a meal rather than before night.
14. It is suggested that nonresponders to PPIs get medical therapy on a regular basis.
15. In patients with LA grade C or D esophagitis, maintenance PPI medication, as well as anti-reflux surgery, are suggested forever.
16. Baclofen is not advised in the absence of evidence of gastroesophageal reflux disease. Without proof of gastroparesis, a prokinetic agent should not be utilised. Sucralfate is not advised for GERD during pregnancy.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The author is a practising super specialist from New Delhi.