Empirical therapy

In patients with symptoms suggestive of GERD, in many instances it will be impossible to gain access to immediate endoscopy or prompt endoscopy appears not necessary at an early stage but rather an exaggerated diagnostic procedure. This seems, according to recent data of the CADET-PE study [27], appropriate since reflux disease is by far the dominating endoscopic diagnosis whereas other benign diagnoses (e.g., peptic gastro-duodenal ulcers) were much less frequent and malignancies were rare and occurring only in patients aged over 50 years. Therefore, approaching a given patient with symptoms suggestive of reflux disease but without any alarm symptoms (e.g., dysphagia, weight loss, anaemia etc), the first option will often be empirical therapy; a prescription of a PPI is recommended due to its superiority over alternative drugs.

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