Delve into the diagnosis and management of GERD and dyspepsia with Dr. Amy Oxentenko (@AmyOxentenkoMD), Gastroenterologist and the Internal Medicine Residency Program Director, Associate Chair for the Department of Internal Medicine, and Professor of Medicine at Mayo Clinic in Rochester, MN. Our discussion features a review of the standard presentations of GERD and dyspepsia, alarm symptoms and who needs referral for endoscopy or other specialized testing (pH, impedance testing, screening for Barrett’s esophagus). Additionally, we comprehensively cover proton pump inhibitor (PPI) therapy including: choice of agent, dose, frequency, how taper, how to counsel patients about risk, what labs should be monitored and the use of adjuvant therapies like H2 blockers, antacids and even carafate. After this episode, you will be flexing on reflux! ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date).  Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | thecurbsiders@gmail.com Credits Written and Produced by: Paul Williams MD, FACP, Beth Garbitelli CME Questions: Beth Garbitelli, Matthew Watto MD, FACP Infographic: Beth Garbitelli  Cover Art: Kate Grant MBChB DipGUMed Hosts:  Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Matthew Watto MD, FACP (written materials); Clair Morgan at Nodderly.com Guest: Amy Oxentenko MD Time Stamps 00:00 Intro, disclaimer, guest bio 02:47 Guest one-liner, Picks of the Week*: Reality TV Shows: Survivor  and Naked and Afraid; Book: Blind Eye: The Terrifying Story Of A Doctor Who Got Away With Murder by James B. Stewart 08:50 Favorite failure 10:55 Best Advice 13:34 A case of GERD, Defining GERD, basic pathophysiology and risk factors 19:18 A bit more on diagnosis of GERD 21:56 Chest pain, mimics of GERD, red flag symptoms 25:12 Are labs required for diagnosis?, testing for Barrett’s esophagus 28:43 Who needs lifelong PPI therapy?, Choice of PPI 33:09 Lifestyle changes and GERD 37:50 H2 blocker vs PPI therapy, Risks of PPI therapy 44:40 How to counsel patients about the risks and benefits of PPI therapy; Recent 3 year RCT investigating safety of PPI therapy 48:18 Adjuvant therapy and further workup for patients with refractory GERD 51:57 pH and impedance studies 54:29 Duration of PPI therapy; Intermittent and On-Demand PPI therapy; Weaning off long term PPI therapy 59:30 Who may benefit from anti-reflux surgery 63:48 Dyspepsia 68:17 Workup of dyspepsia; Definition and diagnosis of functional dyspepsia 74:09 2nd line therapy for dyspepsia (TCAs, Buspirone, GI psychologist, STW 5, complementary and alternative therapies, etc.) 78:13 Take Home Points; Plugs *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Disclosures Dr. Oxentenko reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Citation Oxentenko A, Williams PN, Garbitelli B, Watto MF. “#188 GERD and Dyspepsia with Amy Oxentenko MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. December 16, 2019.