Heartburn

Adolescents with typical symptoms of chronic heartburn should be treated with nonpharmacological lifestyle changes if applicable (diet changes, weight loss, smoking avoidance, sleeping position, no late night eating) and a 4- to 8-week trial of PPI. Regardless of response, after 4–8 weeks of optimal GERD therapy, it is recommended to try to wean the patient from therapy. If symptoms do not improve or recur, additional testing should be considered to determine etiology of symptoms (see Algorithm 2). In certain situations such as lack of access to pediatric gastroenterologist, PPI may be restarted and the patient referred for additional evaluation.