What is first-line medical therapy for GERD-related dysphagia?

• A. H2 receptor antagonists
• B. Proton pump inhibitors
• C. Antacids alone
• D. Prokinetic agents only

Answer: (B)

Suppressing acid to allow healing of the esophagus is the primary approach to GERD-related dysphagia. Proton pump inhibitors best accomplish this by blocking the final step of acid production in the stomach, which lowers acidity, promotes healing of reflux-induced esophagitis, and relieves swallowing difficulties. Their potency and consistent symptom and mucosal healing make them the preferred first-line therapy.

H2 receptor antagonists are milder acid suppressants and may be used if PPIs aren’t tolerated or for milder symptoms, but they’re not as reliable for healing. Antacids provide quick, short-term relief without addressing ongoing acid exposure or mucosal healing. Prokinetic agents, which can improve lower esophageal motility, are not considered first-line due to variable efficacy and tolerability, though they may be added in select cases if symptoms persist despite acid suppression. If dysphagia continues despite adequate PPI therapy, further evaluation is needed.