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Evidence-Based Guidelines for the Treatment, Management of GERD

BETHESDA, Md -- October 21, 2008 -- The American Gastroenterological Association (AGA) Institute has published evidence-based guidelines for the management and treatment of suspected gastroesophageal reflux disease (GERD). The guidelines are published in the October print issue of Gastroenterology.

"As we found in our research, much of the current management of patients with GERD is based on experiences from physicians, uncontrolled trials and expert opinion," said lead author of the guidelines Peter J. Kahrilas, MD, Northwestern University's Feinberg School of Medicine, Chicago, Illinois. "We hope the development of these guidelines will help clinicians better treat patients who present with suspected GERD."

According to the authors, the majority of randomised controlled clinical trials are for pharmacologic therapies for esophageal GERD syndromes, especially acute trials for healing esophagitis. Therefore, many of the highest-level evidence-based recommendations in the guideline are for the acute treatment of heartburn or esophagitis.

"There are many methods physicians are using to treat their patients with GERD, without knowing which is the best one," said John I. Allen, MD, AGA Institute Clinical Practice and Quality Management Committee, Bethesda, Maryland.

"The AGA Institute developed this medical position statement on GERD to encapsulate the major management issues leading to consultations for the treatment of the disease to help guide physicians in treating their patients."

The conclusions of the technical review and medical position statement were based on the best available evidence, or in the absence of quality evidence, the expert opinions of the authors and Medical Position Panel convened to critique the technical review and structure the medical position statement.

In developing the guidelines, the authors used the Montreal consensus definition for GERD, 'a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications.

The strength of the conclusions were determined using the US Preventive Services Task Force grades. Grade A recommendations, which are 'strongly recommended based on good evidence that it improves important health outcomes' include:
· Antisecretory drugs for the treatment of patients with esophageal GERD syndromes. In these uses, proton pump inhibitors (PPIs) are more effective than histamine receptor antagonists (H₂RAs), which are more effective than placebo.
· Long-term use of PPIs for the treatment of patients with esophagitis once they have proven clinically effective. Long-term therapy should be titrated down to the lowest effective dose based on symptom control.
· When antireflux surgery and PPI therapy are judged to offer similar effectiveness in a patient with an esophageal GERD syndrome, PPI therapy should be recommended as initial therapy because of superior safety.
· When a patient with an esophageal GERD syndrome is responsive to, but intolerant of, acid suppressive therapy, antireflux surgery should be recommended as an alternative.
· Twice-daily PPI therapy as an empirical trial for patients with suspected reflux chest pain syndrome after a cardiac etiology has been carefully considered.

Other recommendations include grade B (recommended with fair evidence that it improves important outcomes), grade C (balance of benefits and harms is too close to justify a general recommendation), grade D (recommend against, fair evidence that it is ineffective or harms outweigh benefits), and grade insufficient (no recommendation or insufficient evidence to recommend for or against).

The guidelines can be read here: http://download.journals.elsevierhealth.com/pdfs/journals/0016-5085/PIIS0016508508016065.pdf

SOURCE: American Gastroenterological Association

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