Therapies alternative to acid suppression 
Acid suppression: H2RA or PPI
PPIs are more effective than H2RAs for #GERD
PPIs really don't lose effect.
Keep your 👁 out for potassium competitive acid blockers!
Baclofen is effective in reducing TLESRs and reflux episodes.
What about adjunctive therapy with bile acid binders?
Unfortunately, phase III study was discontinued 😔
Unfortunately, phase III study was discontinued 😔
Alginates theoretically coat the esophagus and protect from acid. Unfortunately the data really don't support their use.
Types III-IV hernias may need surgery. For I-II, assess symptoms and response to PPI.
If PPIs are not helping, consider:
-alternative diagnosis
-medication nonadherence
-mechanical defect (suspect if pyrosis is better but still has regurgitation)
-"refractory #GERD"
- this should actually be "refractory symptoms," because may not actually be acid-related
-alternative diagnosis
-medication nonadherence
-mechanical defect (suspect if pyrosis is better but still has regurgitation)
-"refractory #GERD"
- this should actually be "refractory symptoms," because may not actually be acid-related
💎s on #GERD
-taper to lowest dose of acid suppression
-if not better, look for other diagnosis and/or mechanical defects (especially if regurgitation)
-surgical/endoscopic therapies ONLY when you can prove objective #GERD
-taper to lowest dose of acid suppression
-if not better, look for other diagnosis and/or mechanical defects (especially if regurgitation)
-surgical/endoscopic therapies ONLY when you can prove objective #GERD
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