When should I consider referring a patient with GERD for surgical evaluation, such as fundoplication?

Consider referring a patient with GERD for surgical evaluation, such as fundoplication, if they have a confirmed diagnosis of acid reflux and are either:

• Symptomatic despite adequate symptom control with acid suppression therapy, and do not wish to continue long-term therapy ².
• Responding to a PPI but cannot tolerate acid suppression therapy ².
• Have persistent, refractory, or unexplained symptoms despite treatment ¹.
• Have suspected GORD and are considering surgery, especially if they have risk factors for Barrett's oesophagus, which warrants specialist assessment ¹.