EoE ToT Module 4 References-Katz et al Am J Gastroenterol 2022 ACG Clinical Guidelines for the diagnosis and management of GERD

Katz et al Am J Gastroenterol 2022 ACG Clinical Guidelines for the diagnosis and management of GERD

Pdf Summary

The ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease (GERD) provides updated evidence-based recommendations for the evaluation and management of GERD, including pharmacologic, lifestyle, surgical, and endoscopic strategies. GERD is a common condition treated by gastroenterologists, surgeons, and primary care physicians, characterized by the reflux of gastric contents into the esophagus, causing symptoms like heartburn and regurgitation.<br /><br />Key diagnostic recommendations for GERD are:<br />1. An 8-week trial of empiric proton pump inhibitors (PPIs) for patients with classic symptoms but no alarm symptoms.<br />2. Attempting PPI discontinuation in responsive patients.<br />3. Diagnostic endoscopy for those with persistent symptoms despite PPI treatment or relapse after discontinuation.<br />4. Exclusion of cardiac disease in patients with chest pain before GERD evaluation.<br />5. Avoiding barium swallow solely for GERD diagnosis.<br />6. Endoscopy for patients with dysphagia or alarm symptoms and for those at risk of Barrett’s esophagus.<br />7. Monitoring reflux off therapy when the diagnosis is unclear.<br /><br />GERD management includes:<br />1. Weight loss in overweight/obese patients.<br />2. Avoiding meals before bedtime and tobacco products.<br />3. Use of PPIs over H2-receptor antagonists (H2RA) for healing erosive esophagitis (EE).<br />4. Lowest effective dose of PPI for maintenance therapy.<br />5. On-demand or intermittent PPI therapy for symptom control.<br />6. Avoiding routine addition of other medications in PPI nonresponders.<br /><br />For extraesophageal symptoms like chronic cough and laryngitis, recommendations emphasize evaluating non-GERD causes before attributing symptoms to GERD, and reflux testing before initiating PPI therapy.<br /><br />Refractory GERD management involves:<br />1. Optimizing PPI therapy.<br />2. Esophageal pH monitoring off PPIs if prior objective GERD diagnosis is lacking.<br />3. Impedance-pH monitoring on PPIs for persistent symptoms.<br />4. Considering surgery or endoscopic therapy for persistent regurgitation.<br /><br />Surgical and endoscopic options for GERD include fundoplication, magnetic sphincter augmentation (MSA), and Roux-en-Y gastric bypass (RYGB), recommended based on patient-specific factors and objective evidence of reflux.<br /><br />Despite recent scrutiny on PPIs regarding safety for long-term use, they remain the mainstay of GERD treatment, with their benefits generally outweighing theoretical risks. Regular patient follow-up and consideration of alternative treatments for suitable candidates are emphasized to provide comprehensive GERD management. <br /><br />This guideline provides a detailed framework for clinicians to diagnose and manage GERD effectively, incorporating the latest advances and ensuring patient-centered care.

Keywords

GERD

proton pump inhibitors

diagnostic endoscopy

reflux monitoring

lifestyle modifications

surgical options

Barrett’s esophagus

extraesophageal symptoms

refractory GERD

patient-centered care