By vgreene, 26 May, 2015 Options: laparoscopic fundoplication or bariatric sx. Obese pts should be considered for gastric bypass [C/M]. Current endoscopic tx or transoral incisionless fundoplication<sup>26</sup> not recommended as alternative to traditional med/surg tx [C/M]
By vgreene, 26 May, 2015 Pre-op ambulatory pH monitoring is mandatory in pts w/o evidence of erosive esophagitis. All pts need pre-op manometry to r/o achalasia or scleroderma-like esophagus [S/M]
By vgreene, 26 May, 2015 Surgery w/ experienced surgeon is as effective as medical tx in carefully selected chronic GERD pts [S/H].<sup>24</sup> Referral reasons include: desire to d/c medical tx, noncompliance, medical tx side-effects, etc<sup>25</sup>
By vgreene, 26 May, 2015 Prescribe PPI<sup>21</sup> at lowest effective dose, incl. on-demand or intermittent tx [C/L]
By vgreene, 26 May, 2015 If pts experience heartburn relief<sup>22</sup> w/ H2RA: H2RA can be a maintenance option in pts w/o erosive dz [C/M]
