Quick Reference
Refractory GERD Quick Reference
Evidence-based criteria and algorithms at your fingertips
Conclusive FOR GERD
Any ONE criterion is sufficient
LA Grade C or D esophagitis
Endoscopy
Long-segment Barrett's esophagus (≥1 cm)
Endoscopy
Peptic stricture
Endoscopy
AET >6%
pH Testing (OFF PPI)
Supportive Evidence
Need ≥2 if AET 4-6%
AET 4-6% (borderline)
pH Testing
>80 reflux episodes
Impedance
MNBI <2292 Ω
Impedance
PSPW index <61%
Impedance
SAP ≥95% or SI ≥50%
Symptom correlation
LA Grade A/B esophagitis
Endoscopy
Histopathologic changes (DIS)
Biopsy
Against GERD
Suggests alternative diagnosis
AET <4%
pH Testing
<40 reflux episodes
Impedance
Normal endoscopy (no esophagitis)
Endoscopy
Negative symptom correlation
pH-Impedance