Surgical endoscopic anti reflux procedures If primary unresolved sx is regurgitation consider MSA TIF5 or fundoplication without pH monitoring also consider anti reflux procedures in those w abnl impedance pH testing alternatively escalate medical tx 2 LA

<strong>Surgical/endoscopic anti-reflux procedures:</strong> If primary unresolved sx is regurgitation, consider MSA, TIF⁵ or fundoplication without pH monitoring; also consider anti-reflux procedures in those w/ abnl impedance pH testing (alternatively, escalate medical tx),² LA grade C or D esophagitis, large hiatal hernias;² consider Roux-en-Y gastric bypass in obese pts²