Management of gastro-esophageal reflux disease: Practice-oriented answers to clinical questions

Table 1 Practice-oriented answers to clinical questions on the management of gastro-esophageal reflux disease

No.	Question	Answer
1	Should I perform endoscopy in all patients with GERD symptoms?	Endoscopy should be reserved for patients with GERD symptoms and either alarm features or multiple risk factors for Barrett’s esophagus
2	Is erosive esophagitis specific for diagnosis of GERD?	Only LA grade C and D esophagitis are always specific for GERD
3	When to perform esophageal biopsies in patients with GERD symptoms?	Esophageal biopsies should be performed only when eosinophilic esophagitis is suspected
4	Should hiatal hernia always be identified and measured?	Hiatal hernia should always be identified and measured
5	Should patients with erosive esophagitis undergo repeat endoscopy after treatment?	Only patients with LA grade C and D esophagitis should undergo repeat endoscopy after PPI therapy
6	Is an instrumental finding of laryngitis a specific sign of GERD?	Laryngoscopic findings of laryngitis are not specific signs of GERD
7	Is pH monitoring alone inferior to impedance-pH monitoring to diagnose GERD?	Impedance-pH monitoring is the test of choice to confirm or rule out GERD
8	How should I manage PPI therapy before impedance-pH monitoring?	The choice of performing impedance-pH monitoring off-PPI or on-PPI depends on the clinical goal
9	When should I verify patient adherence to PPI therapy?	Adherence to PPI therapy should be always verified in case of PPI-refractory symptoms
10	When do I refer a patient with PPI-refractory symptoms to anti-reflux surgery?	Only patients with PPI-refractory GERD confirmed by impedance-pH monitoring should be referred to surgical fundoplication
11	Which is the role for prokinetics in patients with GERD?	Prokinetics may be used in patients with GERD and concomitant dyspeptic symptoms
12	Which is the role for P-CABs in patients with GERD?	P-CABs are promising antisecretory drugs, however more evidence is needed

GERD: Gastro-esophageal reflux disease; PPI: Proton-pump inhibitor; LA: Los Angeles; P-CABs: Potassium-competitive acid blockers.