The Curbsiders Internal Medicine Podcast #501 GERD vs NERD: Reflux Updates with Dr. James Callaway
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Oct 13, 2025 Dr. James Callaway, an associate professor and expert gastroenterologist, shares invaluable insights on gastroesophageal reflux disease (GERD) and non-erosive reflux disease (NERD). He discusses when to initiate ambulatory reflux monitoring and the circumstances that warrant long-term PPI therapy. Listeners will learn about the mechanisms behind reflux, the importance of differentiating between erosive and non-erosive conditions, as well as strategies to manage and taper off PPIs effectively. Callaway also highlights the significance of patient-centric care in treatment.
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Scouting And A Marathon Helped Him Persist
- James Callaway spends time outdoors with his three sons through Scouting and monthly camping trips.
- He credits a running buddy for helping him finish his first marathon when he wanted to quit at mile 20.
Short PPI Trial For Typical Heartburn
- For typical heartburn start an 8-week trial of a PPI at 40 mg omeprazole-equivalent, taken 30–60 minutes before the first meal.
- Limit initial prescriptions (no automatic refills) and reassess rather than committing to long-term therapy.
Differentiate Erosive Versus Non-Erosive Disease
- Distinguish erosive GERD from non-erosive (NERD) because erosive disease predicts higher risk of complications and often needs long-term PPI.
- Non-erosive patients are better candidates for periodic trial discontinuation and objective testing before chronic therapy.