EoE Guidelines-ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease

ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease

Pdf Summary

The American College of Gastroenterology's new clinical guidelines for GERD provide updated, evidence-based recommendations for diagnosis and management, reflecting advancements and addressing concerns over existing treatments. GERD remains a prevalent condition, prompting significant clinical attention.<br /><br />Key updates highlight the role of Proton Pump Inhibitors (PPIs), which, although effective, are scrutinized for potential long-term side effects and overprescription issues. The guidelines emphasize a step-wise approach to managing GERD, prioritizing lifestyle modifications such as weight loss, dietary adjustments, and head-of-bed elevation before escalating to pharmacological options like PPIs, which should ideally be administered 30-60 minutes before meals for optimal effectiveness.<br /><br />For diagnosis, the guidelines recommend an empirical 8-week trial of PPIs for patients with classic GERD symptoms, reserving endoscopy for cases that do not respond to initial treatment or exhibit alarm symptoms such as dysphagia or GI bleeding. Barium swallow tests are not recommended as a sole diagnostic tool.<br /><br />Exploring alternatives to medication, the guidelines discuss surgical and endoscopic interventions such as fundoplication and Magnetic Sphincter Augmentation (MSA) for patients with persistent symptoms or large hiatal hernias. MSA is noted as a viable alternative to laparoscopic fundoplication, showing promise in patients with documented reﬂux-related regurgitation not adequately controlled by medication alone.<br /><br />The guidelines underscore the necessity of confirming GERD diagnosis through objective testing, especially when contemplating surgical or invasive intervention. Notably, endoscopic and surgical interventions for extraesophageal manifestations of GERD should be judiciously considered, ensuring objective evidence supports GERD as the symptom source.<br /><br />Ultimately, the guidelines advocate individualized patient management, taking into account personal health profiles and potential risks, thereby supporting clinicians in delivering informed, patient-centered care.

Keywords

GERD

clinical guidelines

Proton Pump Inhibitors

lifestyle modifications

diagnosis

endoscopy

fundoplication

Magnetic Sphincter Augmentation

individualized management

patient-centered care