Figure 3.

Algorithm for proven GERD treatment, which includes medical, surgical, and endoscopic treatment. Medical treatment includes lifestyle modification, optimization of PPI treatment, and adjunctive treatment, which should be tailored to the GERD phenotype. If antireflux surgery or endoscopic treatment is planned, the first step is high-resolution esophageal manometry and/or a barium esophagram to assess the esophageal function and rule out contraindications such as achalasia. Endoscopic treatments such as TIF, ARMA, and Stretta should not be offered to patients with hiatus hernia >2 cm or severe esophagitis LA grade C and D. Surgical treatments include laparoscopic fundoplication and MSA. RYGB may be considered for obese patients with proven GERD. ARMA = antireflux mucosal ablation, GERD = gastroesophageal reflux disease, H2RA = histamine type-2 receptor antagonist, LA = Los Angeles, MSA = magnetic sphincter augmentation, P-CAB = potassium-competitive acid blocker, PPI = proton pump inhibitor, RYGB = Roux-en-Y gastric bypass, TIF = transoral incisionless fundoplication