By vgreene, 26 May, 2015 If nocturnal sx, sleep disturbance, &/or variable schedules: consider dose-timing<sup>11</sup> adjustment &/or bid dosing [S/L]. Bedtime H2RA tx can be added prn to daytime PPI in pts w/ nighttime sx, but tachyphylaxis may occur after several wks [C/L]
By vgreene, 26 May, 2015 Increase PPI dosing<sup>11</sup> to bid or consider a switch to a different PPI<sup>12</sup> [C/L]
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]
