- Gastroesophageal reflux disease (GERD) is a common clinical problem that affects millions worldwide, with patients experiencing both classic and atypical symptoms. - Acid suppressive therapy provides relief of symptoms and prevents complications for many individuals with GERD. Fundoplication is a surgical treatment option. - Diagnosis and management may involve trials of proton pump inhibitors, endoscopy, pH testing, and manometry depending on symptom response and findings. Lifestyle changes and proton pump inhibitors are first-line approaches for treatment.

1. Take home messages
• Gastroesophageal reflux disease (GERD) is
a common clinical problem, affecting
millions of people worldwide.
• Patients are recognized by both classic and
atypical symptoms.
• Acid suppressive therapy provides
symptomatic relief and prevents
complications in many individuals with
GERD.
• Fundoplication is surgical treatment.

2. MCQs
• A diagnosis of gastroesophageal reflux
disease implies that a patient has which
of the following functional abnormalities?
A.Compression of the esophagus from a
double aortic arch
B.Cricopharyngeal incoordination
C.Denervation of esophageal muscle
D.Lower esophageal sphincter incompetence

3. MCQs
• A patient who has symptoms of
gastroesophageal reflux disease (GERD) is
prescribed a trial of proton pump inhibitors.
One month later the symptoms have not
improved despite treatment, and findings on
endoscopy are unremarkable. Which of the
following is the most appropriate next step in
management?
• A.Barium swallow x-ray study
• B.Esophageal manometry
• C.Repeat endoscopy in one month
• D.24-hour pH testing

4. MCQs
• A patient who has symptoms of
gastroesophageal reflux disease (GERD) is
prescribed a trial of proton pump inhibitors.
One month later the symptoms have not
improved despite treatment, and findings on
endoscopy are unremarkable. Which of the
following is the most appropriate next step in
management?
• A.Barium swallow x-ray study
• B.Esophageal manometry
• C.Repeat endoscopy in one month
• D.24-hour pH testing

5. MCQs
• Which of these is considered an "alarm symptom"
suggestive of complicated GERD?
A. Excessive belching/flatulence
B. Epigastric pain
C. Nausea
D. Odynophagia

6. MCQs
• Which of these is considered an "alarm symptom"
suggestive of complicated GERD?
A. Excessive belching/flatulence
B. Epigastric pain
C. Nausea
D. Odynophagia

7. MCQs
• which is most accurate regarding the workup for
GERD?
A. Barium radiography is routinely recommended in
the diagnosis of GERD
B. A presumptive diagnosis of GERD can be made
and empirical proton pump inhibitor (PPI)
therapy initiated in the setting of typical
symptoms of heartburn and regurgitation without
additional studies
C. Upper endoscopy is required for diagnosis of
GERD in all patients
D. Specific diagnosis of GERD can only be made
with biopsies obtained from the distal esophagus

8. MCQs
• which is most accurate regarding the workup for
GERD?
A. Barium radiography is routinely recommended in
the diagnosis of GERD
B. A presumptive diagnosis of GERD can be made
and empirical proton pump inhibitor (PPI)
therapy initiated in the setting of typical
symptoms of heartburn and regurgitation without
additional studies
C. Upper endoscopy is required for diagnosis of
GERD in all patients
D. Specific diagnosis of GERD can only be made
with biopsies obtained from the distal esophagus

9. MCQs
• Which of these is most commonly
recognized as an "alarm symptom" that
suggests potentially serious complications
associated with GERD?
A. Dysphagia
B. Constipation
C. Epigastric pain
D. Foul-smelling gas

10. MCQs
• Which of these is most commonly
recognized as an "alarm symptom" that
suggests potentially serious complications
associated with GERD?
A. Dysphagia
B. Constipation
C. Epigastric pain
D. Foul-smelling gas

11. MCQs
• Which of these is best established as a risk
factor for GERD?
A. Epilepsy
B. Diabetes
C. Male sex
D. Use of beta-blockers

12. MCQs
• Which of these is best established as a risk
factor for GERD?
A. Epilepsy
B. Diabetes
C. Male sex
D. Use of beta-blockers

13. MCQs
• Which of these medications is most likely to
increase acid reflux and worsen GERD
symptoms?
A. Metformin
B. Levothyroxine
C. Amitriptyline
D. Warfarin

14. MCQs
• Which of these medications is most likely to
increase acid reflux and worsen GERD
symptoms?
A. Metformin
B. Levothyroxine
C. Amitriptyline
D. Warfarin

15. MCQs
• In addition to upper gastrointestinal (GI)
endoscopy, which of these is most routinely
a part of the workup for GERD?
A. Nuclear medicine gastric emptying study
B. CT
C. Manometry
D. Ultrasonography

16. MCQs
• In addition to upper gastrointestinal (GI)
endoscopy, which of these is most routinely
a part of the workup for GERD?
A. Nuclear medicine gastric emptying study
B. CT
C. Manometry
D. Ultrasonography

17. MCQs
• Which is most accurate about GERD
treatment?
A. Lifestyle changes remain the cornerstone of GERD
management
B. PPIs are now preferred to histamine 2–receptor
antagonists as first-line therapy for most patients with
mild to moderate GERD symptoms and grade I-II
esophagitis
C. Chocolate has been found to be beneficial when included
in the diet of patients with GERD
D. Cardiac conduction defects are a contraindication to
surgical intervention for GERD

18. MCQs
• Which is most accurate about GERD
treatment?
A. Lifestyle changes remain the cornerstone of GERD
management
B. PPIs are now preferred to histamine 2–receptor
antagonists as first-line therapy for most patients with
mild to moderate GERD symptoms and grade I-II
esophagitis
C. Chocolate has been found to be beneficial when included
in the diet of patients with GERD
D. Cardiac conduction defects are a contraindication to
surgical intervention for GERD

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