Don’t forget about H. Pylori! This gram-negative bacteria is more common than you think.
If you have a patient complaining of dyspepsia (epigastric discomfort, bloating, acid reflux, nausea, belching) and standard GERD treatment such as a PPI has failed them or symptoms continue to return, then consider testing for H. pylori.
The cheapest and most widely available test is through serological testing or the fecal antigen test. Be aware though, you can have positive results from serology from previous infections. Additionally, fecal antigen tests can have false negative results in the presence of PPI use. Personally, I perform serological testing and test for the IGG and IGM antibodies. If the IGM is positive, then I begin treatment.
Typical treatment includes triple therapy including acid suppression and antibiotics. You can look up specific protocols online as there are multiple options.
Once treated, you then want to confirm eradication with additional testing 4 weeks after antibiotics are stopped and at least 2 weeks after the PPI has been stopped to ensure the patient is free from this nasty bug.