continuing the life style changes and add H2RAs to the patient regime for 4 to 8 weeks. If the symptoms continue, initiate step three by adding proton pump inhibitors (PPI) to the patient’s regime for the next 4 to 8 weeks. If the symptoms still persist, refer the patient to a gastroenterologist (Woo & Wynne, 2012). The step-down approach includes a three step approach as well. Step one consists of lifestyle changes to include diet, weight loss and smoking cessation and PPI standard dose every morning for about 8 weeks (Woo & Wynne, 2012). If the patient’s symptoms improve, then decrease the patient’s PPI or change to H2RA. If patient’s symptoms persist, start step two. Step two consist of increasing the patients PPI to twice a day for the next 4 to 8 weeks. If it continues at this point then refer the patient to a gastroenterologist (Woo & Wynne, 2012). Woo & Wynne state “The step-down approach is most appropriate for patients with moderate to severe disease and/or daily symptoms” (2012). What labs or other diagnostic tests that are used to confirm GERD? Diagnostic tests used to confirm GERD are the upper endoscopy and x-ray of the upper digestive system. Woo & Wynne state “The American Gastroenterological Association (AGA) recommends no routine testing for straightforward GERD” (2012). If a patient does not respond to treatment of proton pump inhibitors twice a day then diagnostic testing would be done because then there is a concern of gastric malignancy or misdiagnosis (Woo & Wynne, 2012).

References Buttaro, T. M., Trybulski, J., Polgar-Bailey, P., Sandberg-Cook, J. (2017). Primary care: A collaborative practice, 5th Edition. Henricks, M., (2016). GERD treatment. Retrieved from Woo, T. M., Wynne, A. L., (2012). Pharmacotherapeutics for nurse practitioner prescribers, 3rd Edition.