• Key idea: Patients with symptoms of GERD who are under 50 years old with symptoms for <5 years, no cancer risk factors and no alarm symptoms (melena, hematemesis, weight loss, anemia, dysphagia/odynophagia, etc.) should receive a trial of PPI therapy
• Key idea: Patients who are 50+ years old with symptoms for >5 years or cancer risk factors or alarm symptoms would first receive an endoscopy

https://step-prep.org/tutoring/

This is a younger pt that presents with all the signs & symptoms of GERD (retrosternal chest pain, cough, sour taste, ect). Thus, a trial PPIs is recommended

Moreover, he presents with no alarm symptoms (unexplained weight loss, dysphagia, masses, older male with prolonged symptoms, ect). If any of these symptoms are present that an endoscopy is indicated. Smoking alone in a younger pt is not an indication for an endoscopy.