In May, 2013, the American College of Gastroenterology has published new guidelines for diagnosing and managing gastroesophageal reflux disease (GERD). Dr. Lauren B. Gerson from Stanford University School of Medicine, California, a member of the guidelines panel, highlighted six areas where the guidelines changed since the 2005 version:
1) Weight loss, bed elevation (for patients with nocturnal GERD symptoms), is an effective lifestyle measure. Avoidance of foods thought to provoke reflux is not routinely advised.
2) Routine screening and treatment for H. pylori infection are not recommended because there isn't enough evidence that testing and treatment will affect GERD symptoms.
3) While the guidelines continue to advise against routine biopsies of the distal esophagus to diagnose GERD, eosinophilic esophagitis (EoE) has become more recognized since the 2005 guidelines. Therefore, biopsies of the distal and mid-esophagus should be obtained when EoE is suspected.
4) Since the last guidelines, there have been multiple concerns regarding the long-term safety of Proton Pump Inhibitors (PPIs). There does not appear to be an increased risk of osteoporosis, except in patients with other risk factors for hip fracture. There also does not appear to be an increased risk of cardiovascular events in patients using concomitant clopidogrel. PPI therapy does appear to be a risk factor for the development of Clostridium difficile infection.
5) GERD can be considered to be a co-factor for patients with extra-esophageal symptoms including cough, laryngitis, and asthma. While a PPI trial can be recommended in patients who also have typical GERD symptoms, reflux monitoring should be considered before a PPI trial in patients without GERD symptoms. Evaluation for non-GERD causes should occur in all patients.
6) Endoscopic therapy is not recommended as therapy for GERD. Obese patients with GERD should consider gastric bypass surgery as treatment for heartburn symptoms.
To review all the new guidelines, Click HERE.
Am J Gastroenterol 2013.