Guidance updated on reflux disease diagnosis, treatment

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The American College of Gastroenterology has updated guidelines on diagnosing and treating gastroesophageal reflux disease for the first time in 13 years, HCPLive reported Nov. 22.

The new guidelines call for the lowest effective dosage of proton pump inhibitors to avoid overprescribing.

For diagnosing gastroesophageal reflux disease, the academy recommended an eight-week empiric trial of proton pump inhibitors taken once daily prior to a meal for patients with symptoms of heartburn and regurgitation. Patients who respond to the medication can discontinue use.

It also recommended conducting a diagnostic endoscopy two to four weeks after proton pump inhibitors are discontinued for patients who do not respond to the eight-week trial or for patients whose symptoms return.

Physicians should conduct objective testing for gastroesophageal reflux disease for patients with chest pain that's not related to heartburn and who have been found to not have heart disease.

The academy said barium swallow, reflux-monitoring therapy and high-resolution manometry should not be used solely as diagnostic tests for patients meeting certain criteria and that endoscopies should be the first test for patients with dysphagia, symptoms such as weight loss and gastrointestinal bleeding, and those with risk factors for Barrett’s esophagus.

It also made several recommendations on management of the disease, including weight loss, bed elevation and avoiding tobacco products. It recommended against multiple management techniques, including medical therapies in patients who don't respond to proton pump inhibitors.

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