Gastroesophageal reflux disease
ICD-10 K21 · ICD-11 DA22

Extraesophageal GERD with Heartburn — When Twice-Daily PPI Therapy Has Not Helped

Clinical Scenario

This protocol applies to patients presenting with extraesophageal manifestations of GERD — such as chronic cough, hoarseness, or laryngitis — alongside typical GERD symptoms including heartburn and/or regurgitation.

Previous Treatment — Goal Not Reached

The initial approach was a trial of twice-daily PPI therapy for 8 to 12 weeks. This protocol is indicated when that treatment did not achieve improvement of the extraesophageal symptoms.

Next-Line Approach (Partial Overview)

When objective evidence of reflux is present, the next step may involve a surgical or endoscopic anti-reflux procedure. Full patient-selection criteria, sequencing, and the complete structured regimen are available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.14309/ajg.0000000000001538

For patients who have both extraesophageal and typical GERD symptoms we suggest considering a trial of twice-daily PPI therapy for 8 to 12 weeks prior to additional testing.

In patients treated for extraesophageal reflux disease, surgical or endoscopic anti-reflux procedures are only recommended in patients with objective evidence of reflux.

View source ↗