GERD Practice Update Emphasizes Personalized Care

New guidance on helping patients with symptoms of gastroesophageal reflux disease (GERD) emphasizes a personalized diagnostic and therapeutic approach. The 14 best practice advice statements were published online ahead of print in Clinical Gastroenterology and Hepatology.

The guidance stems from an expert review of the literature, as well as discussion and expert opinion aimed at providing practical advice, explained lead author Rena Yadlapati, MD, of the University of California San Diego School of Medicine, and coauthors.

In addition to developing a care plan using shared decision-making with the patient, the guidance advises patient education as well as a 4- to 8-week trial of proton pump inhibitors (PPIs) in patients with troublesome heartburn, regurgitation, and/or noncardiac chest pain without alarm symptoms.

“If PPI therapy is continued in a patient with unproven GERD, clinicians should evaluate the appropriateness and dosing within 12 months after initiation, and offer endoscopy with prolonged wireless reflux monitoring off PPI therapy to establish appropriateness of long-term PPI therapy,” the advice states.

If patients do not respond adequately to PPIs or if alarm symptoms are present, the guidance recommends investigation via endoscopy and, in some cases, prolonged wireless pH monitoring without medication to confirm and phenotype GERD.

Adjunctive agents such as alginate antacids, nighttime H2 receptor antagonists, baclofen, and prokinetics should be personalized to the GERD phenotype. Meanwhile, pharmacologic neuromodulation and behavioral health referral are appropriate in cases involving hypersensitivity or behavioral disorders, according to the guidance. Surgical and other invasive procedures are also addressed.

—Jolynn Tumolo

Reference:
Yadlapati R, Gyawali CP, Pandolfino JE. Personalized approach to the evaluation and management of gastroesophageal reflux disease. Clin Gastroenterol Hepatol. Published online ahead of print February 2, 2022.