Clinical Guidelines for the diagnosis and management of GERD

Gastro esophageal reflux disease (GERD) is a condition in which gastroesophageal reflux (GER) causes esophageal mucosal injuries, annoying symptoms, or both. It is classified into Reflux Esophagitis with esophageal mucosal injuries and Non-Erosive Reflux Disease with symptoms alone.
Pathophysiology of GERD:
The pathophysiology of GERD includes a poorly functioning esophago-gastric junction; the anti-reflux barrier composed of the Lower Esophageal Sphincter (LES) and crural diaphragm, coupled with impaired esophageal clearance and alterations in esophageal mucosal integrity.
Clinical Features:
Typical symptoms include heartburn and regurgitation. Chest pain, indistinguishable from cardiac pain, may present in conjunction with heartburn and regurgitation as the only symptom. Extra-esophageal manifestations include laryngeal and pulmonary symptoms such as hoarseness, throat clearing, and chronic cough and conditions such as laryngitis, pharyngitis, and pulmonary fibrosis. It also has been proposed that GERD might exacerbate asthma.
Diagnosis of GERD:
There is no gold standard for the diagnosis of GERD. Thus, the diagnosis is based on a combination of symptom presentation, endoscopic evaluation of esophageal mucosa, reflux monitoring, and response to therapeutic intervention.
Most consensus statements and guidelines advocate a 2 weeks trial of therapy with a PPI as a diagnostic “test” in patients with the typical symptoms of heartburn and regurgitation, with the underlying assumption that a PPI response establishes the diagnosis of GERD.