Approach to the initial management of patients with GERD

* Upper endoscopy is not required in the presence of typical GERD symptoms of heartburn or regurgitation. We recommend an upper endoscopy if the diagnosis of GERD is unclear and to evaluate alarm features or abnormal imaging if not performed within the last three months. Upper endoscopy should also be performed to screen for Barrett's esophagus in patients with risk factors. Refer to UpToDate content on management of GERD.
¶ Patients with erosive esophagitis or Barrett's esophagus should remain on maintenance acid suppression with a PPI, as they are likely to have recurrent symptoms and complications if acid suppression is decreased or discontinued.