ACG issues new guidelines for diagnosis, management of GERD

The American College of Gastroenterology has released updated treatment guidelines for gastroesophageal reflux disease, according to a press release.

The guidelines, developed by Philip O. Katz, MD; Lauren B. Gerson, MD, MSc; and Marcelo F. Vela, MD, MSCR; appear in the March issue of The American Journal of Gastroenterology.

“GERD is arguably the most common disease encountered by the gastroenterologist,” the authors wrote. “It is equally likely that the primary care providers will find that complaints related to reflux disease constitute a large proportion of their practice.”

The condition is present in an estimated 10% to 20% of the Western world, with regurgitation observed in 16% and clinically troublesome heartburn in 6% of the population.

The guidelines offer recommendations for the diagnosis and management of GERD based on the systematic review and meta-analysis of research conducted from 1960 to 2011, plus reviews of clinical trials. Risk factors for GERD, treatment options, complications such as Barrett’s esophagus, erosive esophagitis and peptic stricture and extraesophageal symptoms such as laryngitis, asthma and chronic cough also are discussed in the release.

Although GERD patients typically are warned to avoid foods and beverages that can aggravate the condition, the authors recommend against the global elimination of such items.

“There have been no studies conducted to date that have shown clinical improvement in GERD symptoms or complications associated with cessation of coffee, caffeine, chocolate, spicy foods, citrus, carbonated beverages, fatty foods or mint,” the authors wrote.

Cessation of alcohol and tobacco use also were not found to improve symptoms or esophageal pH or sphincter pressure, although consuming tobacco, carbonated beverages and chocolate were linked to reduced lower esophageal sphincter pressure.

Among GERD patients treated with proton pump inhibitors (PPIs), the authors note an increased risk for Clostridium difficile infection, as well as community-acquired pneumonia among short-term users, the release said. Patients on PPIs may use clopidogrel concomitantly, as the evidence review indicated no increased risk for cardiovascular events. Also, patients with osteoporosis can receive long-term PPI therapy in the absence of other factors that increase their risk for hip fracture.