EoE ToT Module 4 References-Iwakiri et al J Gastroenterology 2022 Evidence based clinical practice guidelines for GERD 2021

Iwakiri et al J Gastroenterology 2022 Evidence based clinical practice guidelines for GERD 2021

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The "Evidence-based Clinical Practice Guidelines for Gastroesophageal Reflux Disease (GERD) 2021," issued by the Japanese Society of Gastroenterology (JSGE), provide updated recommendations for the diagnosis and treatment of GERD. These guidelines mark the third edition, incorporating new research findings and treatments, especially the introduction of vonoprazan, a potassium-competitive acid blocker (P-CAB), alongside traditional proton pump inhibitors (PPIs).<br /><br />Key updates and recommendations in the 2021 guidelines include:<br /><br />1. **Treatment Algorithms:**<br />   - GERD is divided into reflux esophagitis (RE) and non-erosive reflux disease (NERD).<br />   - Treatment varies based on whether GERD is classified as severe RE, mild RE, or NERD.<br /><br />2. **Medication Recommendations:**<br />   - For severe RE, vonoprazan is recommended as both initial and maintenance therapy. <br />   - For mild RE, either PPI or vonoprazan can be used initially, with PPI or vonoprazan for maintenance.<br />   - For NERD, PPIs are recommended initially, with the possibility of maintenance therapy or on-demand treatment.<br /><br />3. **Diagnostic and Treatment Approaches:**<br />   - GERD diagnosis involves clinical assessments, endoscopy, and, if needed, proton pump inhibitors (PPI) tests.<br />   - Treatment for refractory cases may include impedance-pH monitoring and esophageal manometry.<br /><br />4. **Surgical Treatment:**<br />   - Anti-reflux surgery is suggested for PPI-resistant GERD.<br />   - Postoperative esophagitis management includes re-evaluating surgical techniques and adding anti-reflux procedures.<br /><br />5. **Long-term Management and Safety:**<br />   - Long-term PPI therapy is generally safe but requires careful monitoring for potential adverse effects.<br /><br />6. **Emerging Medications:**<br />   - The positioning of new medications like vonoprazan shows a potential shift in treating GERD, highlighting its superior efficacy in certain conditions compared to traditional PPIs.<br /><br />The guidelines also address background questions (BQ), clinical questions (CQ), and future research questions (FRQ), ensuring a comprehensive approach to GERD treatment and management. The focus on systematic and evidence-based recommendations aims to standardize treatment across various patient profiles and severity levels of the disease. These guidelines are intended for global use, providing a structured approach to diagnosing and treating GERD effectively.

Keywords

GERD

JSGE

vonoprazan

proton pump inhibitors

reflux esophagitis

non-erosive reflux disease

treatment algorithms

anti-reflux surgery

long-term management

emerging medications