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 20 May 2018

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News

Optimal strategies to define and diagnose GERD

The latest issue of the Clinical Gastroenterology & Hepatology developed optimal strategies to define and diagnose gastroesophageal reflux disease.

News image

Gastroesophageal reflux disease (GERD) is a common condition affecting up to 20% of the Western world.

It is a condition that develops when reflux of gastric contents causes troubled symptoms and/or complications.

Heartburn and regurgitation are the 2 cardinal symptoms of GERD, although it may present with other symptoms, such as chest pain; pulmonary, or ear, nose and throat symptoms.

Heartburn and regurgitation have suboptimal sensitivity and specificity in diagnosing GERD.

Dr Michael Vaezi and colleagues from Tennessee, USA investigated optimal strategies to define and diagnose gastroesophageal reflux disease.

The team reported that GERD is found in 54% with heartburn as the dominant symptom, and in 29% with regurgitation as the predominant presenting symptom.

The researchers noted that this is likely caused by significant overlap between GERD, gastroparesis, functional dyspepsia, and eosinophilic esophagitis regarding presenting symptoms of heartburn and regurgitation.

Patients with gastroparesis often complain of heartburn and regurgitation postprandially and acid-suppressive therapy in this group may not adequately ameliorate these symptoms.

Similar to GERD, functional dyspepsia and functional heartburn are both common with likelihood of significant overlap greatest in those with initially suspected nonerosive reflux disease.

The expert panel was charged to provide a written consensus in the area of GERD
Clinical Gastroenterology & Hepatology

Thus, symptoms alone are neither adequately sensitive nor specific to guide therapeutic strategies.

Endoscopic findings in patients with GERD include esophagitis and Barrett’s esophagus. Presence of such findings highly suggests chronic esophageal epithelial exposure to gastroduodenal contents and GERD as the likely diagnosis.

However, most patients with GERD have normal endoscopic findings, thus limiting the utility of this diagnostic test alone in establishing GERD as the etiology of symptoms.

The research team found that the challenge posed to clinicians and researchers is how best to improve current diagnostic and therapeutic strategies in GERD.

In October 2016, the American Gastroenterological Association’s Center for Diagnostics and Therapeutics convened experts from around the country to discuss optimal strategies to define and diagnose GERD.

The team reported that the impetus for this 2-day workshop was to highlight the complexity of the disease process and to generate a roadmap for optimizing GERD diagnosis for potential future enrollment in therapeutic studies.

A series of lectures were followed by a robust discussion of current dilemmas in GERD definition and diagnosis, given the widespread availability of acid-suppressive therapy. Lectures focused on definition, diagnosis, current therapeutic options, and study outcomes.

Dr Vaezi's team concludes, "The expert panel was charged to provide a written consensus on the workshop outcome with the aim of providing clarity for future trials in the area of GERD."

"This is a synopsis of this discussion and the final recommendations."

Clin Gastroenterol Hepatol 2017: 15(8): s 1162–1172
31 July 2017

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