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

Katz et al Am J Gastroenterol 2022 ASG Clinical guideline for the diagnosis and management of GERD

Pdf Summary

The "ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease (GERD)" details the current understanding, diagnostic approaches, and treatment strategies for GERD, a prevalent condition. The document highlights significant developments and examines the efficacy and safety of various treatments.<br /><br />Key components of the guideline include:<br />- <strong>Diagnosis</strong>: Recommended initial empirical treatment involves an 8-week trial of proton pump inhibitors (PPIs) for patients with typical GERD symptoms but no alarm symptoms. Endoscopy is advised if symptoms persist or return after stopping PPIs. For patients with non-resolving chest pain yet negative cardiac evaluations, GERD testing is recommended. The guideline advises against using a barium swallow solely for GERD diagnosis.<br />  <br />- <strong>Management</strong>: Emphasizes lifestyle changes (e.g., weight loss, dietary adjustments, elevating the head of the bed) alongside pharmacological interventions. PPIs are the primary treatment for GERD, preferred over H2 receptor antagonists. The minimal effective dose of PPIs should be used, and maintenance therapy should be considered for severe cases. For refractory cases, optimization of PPI therapy and diagnostic reassessment via esophageal pH monitoring or impedance testing may be necessary.<br /><br />- <strong>Extraesophageal Symptoms</strong>: Patients with potential extraesophageal symptoms (such as asthma or chronic cough) should undergo a thorough evaluation for non-GERD causes. A trial of PPI therapy may be considered before further invasive testing.<br /><br />- <strong>Refractory GERD</strong>: Management includes optimizing PPI therapy, confirming GERD diagnosis through pH monitoring, and considering surgical options such as antireflux surgery or magnetic sphincter augmentation (MSA) for patients with documented reflux.<br /><br />- <strong>Surgical and Endoscopic Interventions</strong>: Laparoscopic Nissen fundoplication and MSA are discussed as surgical options, with the recommendation that such procedures be performed by experienced surgeons. The document advises careful preoperative evaluation to rule out other causes of symptoms. It suggests careful consideration of Roux-en-Y gastric bypass (RYGB) for obese patients. Use of radiofrequency energy (Stretta) is not recommended due to inconsistent efficacy.<br /><br />- <strong>Long-term PPI Usage</strong>: Addresses the controversies surrounding potential adverse effects of long-term PPI use, recommending that patients be informed about the theoretical risks and the outweighing benefits. Long-term usage should be individualized and considered carefully, especially given the potential for small risks of adverse events.<br /><br />The guideline underscores the importance of individualized care, aligning treatment with the specific presentation of GERD in each patient, while weighing the benefits and potential risks of both pharmacologic and surgical options.

Keywords

GERD

diagnosis

management

proton pump inhibitors

lifestyle changes

extraesophageal symptoms

refractory GERD

surgical interventions

long-term PPI usage

individualized care