<prompt> Answer this question truthfullyWhat are the different management options for GERD at different stages of the disease?  <response>: <reason> The first step in managing GERD is typically with PPI medication. Confirmatory diagnosis of GERD is managed with 24-hour ambulatory pH monitoring. GERD alarm symptoms, such as difficulty swallowing, are managed with endoscopy to obtain a biopsy. In cases of GERD complications, such as strictures, Barretts esophagus, or refractory GERD, surgery fundoplication may be necessary. 