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GERD lifestyle and therapy — ABIM Board MCQ

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ModerateGastroenterology/HepatologyGERD lifestyle and therapyABIM Board

A 40-year-old has heartburn and nocturnal regurgitation twice weekly after late meals. He has no dysphagia, bleeding, anemia, weight loss or persistent vomiting. What is the best initial management?

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Correct answer: E — Use lifestyle measures plus an eight-week premeal PPI trial

The best answer is “Use lifestyle measures plus an eight-week premeal PPI trial”. Classic reflux symptoms without alarm features can be managed empirically with weight and meal-timing measures plus an eight-week PPI trial, taken correctly before a meal. Endoscopy is reserved for alarm symptoms, treatment failure or other specific indications. Antifungal therapy, barium testing and opioids do not address uncomplicated GERD.

Reference: ACG 2022 Gastroesophageal Reflux Disease Guideline Summary: https://gi.org/journals-publications/ebgi/schoenfeld_aug2024/