Symptoms & Diagnosis 1.Heartburn and reflux are the most common typical symptoms of GERD, while chest pain, epigastric pain, burning sensation in the epigastrium and belching are atypical symptoms of GERD. 2. Regarding the diagnostic method of GERD, the consensus recommends the proton pump inhibitor test (PPITest) as the easiest and most effective method. 3. Endoscopy is recommended for patients with reflux symptoms at first diagnosis, and esophageal biopsy is not recommended for patients with normal endoscopy. GERD treatment 1.When using proton pump inhibitor (PPI) for treatment, single dose PPI treatment is ineffective, double dose can be used instead, and one PPI is ineffective, try to switch to another PPI. 2.PPI treatment for GERD should be used for at least 8 weeks. 3.Patients with GERD who are effective in PPI but need long-term medication can be considered for anti-reflux surgery, and manometry can be used for preoperative evaluation. 4.Early studies in western countries suggested that the combination of PPI and anti-platelet drugs (clobigrel) increased the incidence of cardiovascular events, but recent prospective studies concluded that there was no effect, and no relevant studies are available in China. 5.For patients with severe esophagitis (LA-C and LA-D grade) and GERD patients with combined esophageal hiatal hernia, it is necessary to take double dose at the beginning of use, rather than double dose when it is ineffective. 6. Maintenance treatment methods include on-demand and long-term treatment. Patients with non-erosive reflux disease (NERD) and mild esophagitis (LA-A and LA-B grades) can use on-demand treatment, while patients with recurrence of symptoms after PPI discontinuation and severe esophagitis (LA-C and LA-D grades) usually need long-term maintenance treatment with PPI. Refractory GERD 1. Although there is no uniform definition of refractory GERD, if symptoms such as heartburn and/or reflux do not improve significantly after 8-12 weeks of double-dose PPI treatment, it is considered refractory GERD, and clinicians may consider other options to treat the patient, such as esophageal impedance-pH monitoring and endoscopy for further evaluation. 2. In the treatment of GERD, it is not uncommon for patients to have poor compliance with PPI therapy; therefore, all patients who fail PPI therapy should be evaluated for compliance and optimized for PPI use before further examination. In terms of drug selection, PPIs with high acid-suppressive strength and small inter-individual differences in metabolic rate are preferred. One study showed that increasing the dose of esomeprazole to 80 mg improved esophageal pH abnormalities and pathologic reflux. In addition, its use for the treatment of erosive esophagitis is not affected by CYP2C19 gene polymorphism. 3. If reflux monitoring suggests that symptom-related acid reflux is still present in patients with refractory GERD, anti-reflux surgical treatment or transient relaxation of the lower esophageal sphincter may be performed after weighing the pros and cons. 4. Surgical treatment for non-acid reflux is not recommended. GERD comorbidities and extra-esophageal symptoms 1, asthma, chronic cough and laryngitis may also cause GERD, so non-reflux factors should be excluded before confirming the diagnosis of reflux disease, and PPI test may be performed if there are typical reflux symptoms. 2.Surgical treatment is not recommended for extraesophageal patients with ineffective PPI, and further evaluation should be done first to find other related causes. 3, Patients with reflux esophagitis, especially those with LA-C and LA-D grades, are recommended to have regular follow-up after treatment. 4, Patients with Barrett’s esophagus are recommended to undergo regular endoscopic review. 5. Patients with combined esophageal strictures need PPI maintenance therapy after dilatation to improve the symptoms of dysphagia and reduce the need for re-dilatation, but no relevant studies have been reported in China.