GERD

A 52-year-old man from Delhi presents with a 3-year history of heartburn occurring 2–3 times per week, worse after heavy meals and lying down at night. He reports regurgitation of food and water brash. Physical examination is unremarkable. Upper endoscopy performed 6 months ago showed no Barrett's oesophagus or erosive changes. He has tried antacids and lifestyle modifications without sustained relief. What is the most appropriate next step in management?

Which of the following is the primary mechanism of action of proton pump inhibitors in the treatment of GERD?

In a patient with GERD refractory to standard-dose PPI therapy, which finding on 24-hour ambulatory pH monitoring would indicate inadequate acid suppression?

A 48-year-old woman from Mumbai with a 5-year history of GERD has been on omeprazole 20 mg once daily for 2 years. She reports persistent heartburn 3–4 times per week despite adherence to therapy. Endoscopy 1 year ago showed mild erosive oesophagitis (Los Angeles grade A) with no Barrett's metaplasia. She denies alarm symptoms. What is the most appropriate next management step?