By vgreene, 26 May, 2015 After r/o cardiac cause: pts w/ noncardiac chest pain should have diagnostic eval before instituting tx [C/M]; consider dx eval w/ endoscopy<sup>8</sup> + pH monitoring, before a PPI trial.<sup>9</sup>
By vgreene, 26 May, 2015 Surgery can be effective in carefully selected pts w/ extraesophageal/atypical symptoms; response rates are lower vs in pts w/ heartburn.<sup>7</sup>
By vgreene, 26 May, 2015 For typical GERD sx nonresponsive to PPI: endoscopy<sup>6</sup> to exclude non-GERD etiologies [C/L]
By vgreene, 26 May, 2015 If refractory GERD after these evals negative: ambulatory reflux<sup>5</sup> monitoring [S/L]
By vgreene, 26 May, 2015 Concomitant evaluation by ENT, pulmonary, and allergy specialists<sup>6</sup> [S/L]
By vgreene, 26 May, 2015 Consider GERD as potential cofactor in pts w/ asthma, chronic cough, or laryngitis; carefully evaluate for non-GERD causes in all pts [S/M]
By vgreene, 26 May, 2015 If alarm sx (eg, dysphagia) or high risk of GERD complications: endoscopy<sup>6</sup> recommended
By vgreene, 26 May, 2015 If no typical GERD sx: reflux monitoring<sup>5</sup> prior to PPI trial [C/L]