In patients with frequent GERD symptoms (eg, >2 times per week) and no alarm signs or symptoms (eg, dysphagia, odynophagia, anorexia, weight loss, evidence of gastrointestinal bleeding), initial treatment is recommended with a daily proton pump inhibitor (PPI) (eg, omeprazole) for at least 8 weeks. Lifestyle changes (eg, smoking cessation, alcohol reduction) should be pursued as well. Such a patient whose symptoms fail to improve with an 8-week trial of low-dose (daily) PPI therapy should generally increase to high-dose (twice daily) PPI therapy for at least 8 weeks prior to any further investigation or intervention.
In patients with mild or infrequent GERD symptoms (and no alarm signs or symptoms), initial therapy with an as-needed histamine-2 receptor blocker (eg, ranitidine) is recommended in combination with lifestyle changes; subsequent step-up to PPI therapy can be performed if needed.