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Esophageal monitoring If you have persistent reflux symptoms for more than 3 months despite adequate treatment, or if you have alarm symptoms (difficulty swallowing, pain with swallowing, unintentional weight loss beyond therapeutic effects, anemia), endoscopic evaluation is appropriate

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But the plan must emphasize: resistance training sufficient protein rate-of-loss control recovery and sleep Only then does it make sense to have a careful conversation about any adjuncts