Curbside Consultation in GERD: 49 Clinical Questions

Philip O. Katz, MD

Question 13: Is An Empiric Trial Of Ppi Therapy Efficacious In Patients With Suspected Gerd? In What Circumstances? (continued)

The initial management of patients with symptoms suspected due to gastroesophageal reflux disease remains controversial. No single approach has diagnostic or therapeutic certainty. Early endoscopy lacks sensitivity for erosive esophagitis—up to 50% or greater will have normal mucosa on traditional endoscopy. Recent studies suggest that microscopic changes can be found in patients with heartburn and a normal endoscopy, suggesting there is a continuum from microscopic to macroscopic disease in some patients. Unfortunately, light microscopy does not reliably identify these changes and…