The American College of Gastroenterology published an update to the association's 2013 clinical guidelines on the diagnosis and management of gastroesophageal reflux disease online in The American Journal of Gastroenterology on Nov. 22.
Six key recommendations for ASC gastroenterologists:
1. Diagnostic endoscopy is recommended for patients with classic GERD symptoms that do not respond adequately to an eight-week trial of proton pump inhibitors, or whose symptoms return when PPIs are discontinued. Endoscopy should be performed after proton pump inhibitors are stopped for two to four weeks
2. Endoscopy is recommended as the first test for evaluation of patients presenting with dysphagia or other serious symptoms such as weight loss and gastrointestinal bleeding. It's also recommended as the first test for evaluation for patients with multiple risk factors for Barrett's esophagus.
3. The ACG recommends anti-reflux surgery or indefinite maintenance PPI therapy for patients with LA grade C or D esophagitis.
4. The ACG suggests that upper endoscopy should not be used to diagnose GERD-related asthma, chronic cough or laryngopharyngeal reflux.
5. The association suggests against diagnosing laryngopharyngeal reflux based on laryngoscopy findings alone and recommends additional testing.
6. In patients treated for extraesophageal reflux disease, the ACG recommends surgical or endoscopic procedures only for those with objective evidence of reflux.