Patient handout

GERD (chronic, empiric-to-maintenance)

PRODUCTION

1. Your condition

This handout is for gerd (chronic, empiric-to-maintenance). Your care team identified this based on: heartburn / pyrosis.

Other reasons your team may use this plan: regurgitation / acid reflux; dysphagia (alarm symptom); chronic cough / laryngeal symptoms (extra-esophageal gerd).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
omeprazole	20 mg PO daily 30 min before breakfast	PO	daily	ACG 2022 Katz — standard-dose PPI x 8 wk is first-line diagnostic-therapeutic maneuver
lansoprazole	30 mg PO daily 30 min before breakfast	PO	daily	ACG 2022 Katz — alternative standard-dose PPI
esomeprazole	20 mg PO daily 30 min before breakfast	PO	daily	ACG 2022 Katz — alternative PPI; S-isomer of omeprazole
pantoprazole	40 mg PO daily 30 min before breakfast	PO	daily	ACG 2022 Katz — alternative PPI; fewer CYP2C19 interactions
rabeprazole	20 mg PO daily	PO	daily	ACG 2022 Katz — alternative PPI
dexlansoprazole	30 mg PO daily	PO	daily	ACG 2022 Katz — dual-release PPI; may be taken without regard to meals

Plan: GERD empiric PPI step-up / step-down / maintenance — ACG 2022 Katz

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — Well controlled — continue maintenance

If you have:

Heartburn <1x/week or none
No regurgitation
No dysphagia
Sleeping well, no nocturnal symptoms

Do this:

Continue current PPI at lowest effective dose (or on-demand if stepped down)
Maintain lifestyle modifications (weight, diet, meal timing, head-of-bed elevation)
Keep Barrett surveillance EGD appointments if applicable
Annual PPI step-down attempt with provider

YELLOW — Worsening — contact provider within 1 week

If you have:

Heartburn >2x/week despite PPI
Regurgitation interfering with sleep or meals
Mild difficulty swallowing (occasional, solids only)
Need for daily antacids on top of PPI

Do this:

Verify PPI timing (30-60 min before breakfast)
Reinforce lifestyle: avoid late meals, elevate head of bed
Schedule appointment with provider to discuss step-up or EGD

Call your provider if:

Symptoms not improving after 2 weeks of adherence to PPI + lifestyle
New or worsening regurgitation

RED — Alarm — seek urgent evaluation

If you have:

Difficulty swallowing solids or liquids (progressive dysphagia)
Painful swallowing (odynophagia)
Vomiting blood or coffee-ground material
Black tarry stools
Unintentional weight loss >5% in 3 months
Food impaction (cannot swallow saliva)

Do this:

Stop eating/drinking if food impaction — go to ED
Seek urgent/emergent evaluation for GI bleeding (ED)
Contact GI for urgent EGD referral

Call your provider if:

Any red zone symptom — do not wait

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Dysphagia, odynophagia, GI bleeding, iron-deficiency anemia, unintentional weight loss, or recurrent vomiting in GERD patient (ACG 2022 Katz)
Barrett esophagus with high-grade dysplasia confirmed on expert pathology review (AGA 2024 Barrett)

5. Follow-up

Symptom reassessment at 8 wk; lifestyle reinforcement (weight loss, head-of-bed elevation, avoid late meals); long-term PPI safety counseling (bone, Mg, C. diff) (ACG 2022 Katz; NICE 2024)

6. Sources

Guideline: ACG 2022 Clinical Guideline: Diagnosis and Management of GERD (Katz Gastroenterology 2022)