When classic gastroesophageal reflux disease symptoms — heartburn and regurgitation — continue despite completing an initial 8-week course of once-daily proton pump inhibitor (PPI) therapy, a structured next-line strategy is warranted. This protocol addresses that specific clinical situation.
The initial line combined lifestyle modifications (including weight management, avoiding meals close to bedtime, tobacco avoidance, trigger food avoidance, and head-of-bed elevation for nighttime symptoms) with an 8-week empiric once-daily PPI trial taken 30 to 60 minutes before a meal. The goal was relief of classic GERD symptoms — heartburn and regurgitation. This protocol applies when that goal was not achieved.