Advanced Practice Provider EoE Program (Live/Virtual) | November 2024-2021_acg_clinical_guideline_for_the_diagnosis

2021_acg_clinical_guideline_for_the_diagnosis_and.14

Pdf Summary

The ACG Clinical Guideline provides updated, evidence-based recommendations for diagnosing and managing Gastroesophageal Reflux Disease (GERD). GERD is a prevalent condition requiring attention from gastroenterologists, surgeons, and primary care physicians. Advances have been made in understanding various GERD presentations, diagnostic testing, and patient management strategies. Proton pump inhibitors (PPIs) are the primary medical treatment for GERD, although concerns have emerged about adverse events and the overprescription of PPIs, especially in long-term use. <br /><br />The guideline recommends an initial 8-week PPI trial for patients with typical GERD symptoms without alarm signals like significant weight loss or gastrointestinal bleeding. If symptoms improve, discontinuation of PPIs should be attempted. For persistent symptoms, further diagnostic approaches such as endoscopy or reflux monitoring are advised. The guideline advises against using barium swallow tests solely for diagnosing GERD and discourages high-resolution manometry as a sole diagnostic test.<br /><br />Lifestyle modifications, including weight loss for overweight patients and avoiding meals near bedtime, can help manage GERD symptoms. PPIs are recommended over H2RA for healing erosive esophagitis (EE) and maintaining healing. For non-erosive reflux disease (NERD), on-demand PPI therapy may be beneficial. If GERD symptoms persist despite PPI therapy, antireflux surgery or transoral incisionless fundoplication (TIF) might be considered, particularly if there is objective evidence of GERD.<br /><br />Regarding extraesophageal GERD symptoms, such as chronic cough or laryngitis, careful evaluation is necessary to avoid misattribution to GERD. Evidence supports evaluating non-GERD causes first and suggests a substantial consideration before surgical treatments in these cases.<br /><br />Long-term PPI use has been under scrutiny due to potential adverse effects like kidney disease, bone fractures, and gastrointestinal infections. However, recent studies suggest these risks are not significant enough to outweigh the benefits of PPIs for treating GERD. The document emphasizes individual patient assessment, consideration of potential risks, and diligent monitoring for any adverse effects during treatment.

Keywords

GERD

ACG Clinical Guideline

proton pump inhibitors

diagnostic testing

lifestyle modifications

endoscopy

antireflux surgery

extraesophageal symptoms

long-term PPI use

patient management