Diagnosis and treatment of gastroesophageal reflux disease

Table 2 Diagnostic Testing for gastroesophageal reflux disease

Diagnostic test	Indication
PPI trial	Classic GERD symptoms with no alarm symptoms.
Esophageal pH monitoring	Refractory symptoms where GERD diagnosis is in question, pre-operative evaluation for non-erosive disease
Upper endoscopy	Alarm symptoms (e.g., dysphagia), PPI unresponsive patients, high risk for Barrett’s esophagus
Barium esophagram	Evaluation of dysphagia, otherwise not recommended for GERD evaluation
Esophageal manometry	Prior to anti-reflux surgery to rule out esophageal dysmotility (e.g., achalasia, scleroderma), otherwise not recommended for GERD evaluation

GERD: Gastroesophageal reflux disease; PPI: Proton pump inhibitor.