fbpx

GERD (Gastroesophageal reflux disease)

Slocum-Dickson Medical Group Clinical Guideline

Refer To Gastroesophageal Specialist if patient has dysphagia, GI bleeding (occult or active), unexplained weight loss, anemia or history gastric surgery.

  1. Lose Weight
  2. Stop Smoking
  3. Decrease Alcohol Intake
  4. Elevate Head of Bed
  5. Do Not Eat 2-3 Hours Before Bedtime
  6. Avoid Caffeine, Chocolate, Mints and Fatty Foods
  7. Avoid Meds That Complicate GERD/Gastritis: CCB’s, Theophylline, ASA, NSAID’s Beta2-Agonists

NO RELIEF – Proceed To Next Step

  1. Antacids
  2. H2 Antagonist: Axid AR, Pepcid AC, Zantac 75

NO RELIEF – Proceed To Next Step

  1. H2 Antagonist:
    Ranitidine 150 – 300mg BID
    Use H2 Blocker for 6 – 8 weeks, Then D/C
    If “Classic” GERD Symptons Recur continue H2 Blocker QHS – BID or Refer to Gastroenterology to Consider EGD

NO RELIEF – Proceed To Next Step

  1. Prevacid 30 mg QD or Prilosec 20 mg QD or Aciphex 20 mg QD
  2. For PTS Taking Prevacid 30 mg QD or Prilosec 20 mg QD Chronically
    If SX Relief Inadequate, Switch To Alternate Product At Same Dose
    If SX Relief Still Inadequate Proceed To STEP 5
  3. Additional Considerations:
    A) Once SX Controlled For 8 – 12 Weeks Attempt To Change SID To QOD Dosing Or Decrease QD Dosing
    B) Pts. > 50 Y/O Who Have Had GERD Or Pt. < 50 Who Have Refractory Symptons Requiring Chronic PPI Therapy SX Have Never Been Endoscoped Should Be Referred To Gastroenterology For EGD.

NO RELIEF – Proceed To Next Step

  1. Gastroenterology Referral -> Consider Further Investigation