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DR Medhat MRCP

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Management of endoscopy proven GERD<br />

No /mild oesophagitis<br />

Severe Oesophagitis<br />

Full dose PPI for 4-8 weeks<br />

Full dose PPI for 8 weeks<br />

Inadequate response Relapse after response Response No response<br />

H2- Blockers<br />

For 1 month<br />

Response<br />

Low dose PPI<br />

on PRN basis<br />

High dose of<br />

initial PPI for 1<br />

month<br />

No response<br />

Annual<br />

review<br />

Long term full<br />

PPI maintanance<br />

No response<br />

Self care<br />

Shift to another<br />

PPI full or high<br />

dose<br />

Still symptomatic<br />

Surgical TTT if<br />

Patient refuse long term<br />

PPI<br />

PPI intolerance<br />

Offer<br />

endoscopy to<br />

R/O Barrett`s<br />

oesophagus<br />

High grade dysplasia<br />

8

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