Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders encountered in primary care. Although heartburn and regurgitation are considered typical symptoms, many patients present with a broader spectrum of complaints, including epigastric pain, belching, postprandial fullness, nausea, or chronic cough. Such diversity of symptoms may complicate diagnosis and delay appropriate treatment.
Current understanding of GERD extends beyond excessive acid exposure alone. Impairment of the anti-reflux barrier, gastrointestinal motility disorders, visceral hypersensitivity, and gut-brain axis dysfunction all contribute to symptom generation and may explain the frequent overlap between GERD and functional dyspepsia.
In patients with typical symptoms and no alarm features, GERD can usually be diagnosed clinically and treated empirically with proton pump inhibitors (PPIs). Endoscopic evaluation should be reserved for patients with alarm symptoms, refractory disease, or selected individuals at increased risk of Barrett’s esophagus. Although PPIs remain the cornerstone of treatment, a substantial proportion of patients experience only partial symptom relief. In such cases, when symptoms suggest coexisting motility disturbances, treatment may require an individualized approach and the addition of a prokinetic agent such as itopride.
This review summarizes current concepts in the diagnosis and management of GERD in primary care, emphasizing the heterogeneity of symptom presentation, the role of symptom phenotyping, indications for endoscopy, and practical treatment strategies for patients with persistent symptoms despite PPI therapy.