Current International Guidelines for the Management of Patients with Gastroesophageal Reflux Disease: Diagnosis and Management of Typical Syndromes
https://doi.org/10.31550/1727-2378-2022-21-6-29-34
Abstract
Objective of the Review: Analysis of the 2022 American College of Gastroenterology clinical guidelines for the diagnosis and treatment of gastroesophageal reflux disease (GERD).
Key points. Empiric proton pump inhibitors (PPIs), symptom analysis, esophagogastroduodenoscopy, pH-impedancemetry, and highresolution manometry are important in the diagnosis of GERD. The main therapies for typical GERD syndromes are dietary modification, weight loss, and PPIs. In patients with non-erosive reflux disease, once a response to treatment has been achieved, PPIs may be discontinued or switched to on-demand PPI therapy. In patients with stage C and D esophagitis, long-term maintenance treatment with a PPI is appropriate.
Conclusion. The recommendations of the American College of Gastroenterology contain a number of important provisions that will be useful to practitioners. However, the clinical and epidemiological situation in Russia is very different from that in Western countries, and this must be taken into account when determining the tactics of managing patients with GERD.
About the Authors
V. V. Tsukanov
Scientific and Research Institute of Medical Problems of the North of the Federal Research Centre “Krasnoyarsk Scientific Centre of the Siberian Branch of the Russian Academy of Science”
Russian Federation
Russian Federation
3-g Partisan Zheleznyak Str., Krasnoyarsk, 660022
A. V. Vasyutin
Scientific and Research Institute of Medical Problems of the North of the Federal Research Centre “Krasnoyarsk Scientific Centre of the Siberian Branch of the Russian Academy of Science”
Russian Federation
Russian Federation
3-g Partisan Zheleznyak Str., Krasnoyarsk, 660022
Yu. L. Tonkikh
Scientific and Research Institute of Medical Problems of the North of the Federal Research Centre “Krasnoyarsk Scientific Centre of the Siberian Branch of the Russian Academy of Science”
Russian Federation
Russian Federation
3-g Partisan Zheleznyak Str., Krasnoyarsk, 660022
References
1. Delshad S.D., Almario C.V., Chey W.D., Spiegel B.M.R. Prevalence of gastroesophageal reflux disease and proton pump inhibitorrefractory symptoms. Gastroenterology. 2020; 158(5): 1250–61.e2. DOI: 10.1053/j.gastro.2019.12.014
2. Kahrilas P.J., Boeckxstaens G., Smout A.J. Management of the patient with incomplete response to PPI therapy. Best Pract. Res. Clin. Gastroenterol. 2013; 27(3): 401–14. DOI: 10.1016/j.bpg.2013.06.005
3. Yadlapati R., Pandolfino J.E. Personalized approach in the work-up and management of gastroesophageal reflux disease. Gastrointest. Endosc. Clin. N. Am. 2020; 30(2): 227–38. DOI: 10.1016/j.giec.2019.12.002
4. Cremonini F., Wise J., Moayyedi P., Talley N.J. Diagnostic and therapeutic use of proton pump inhibitors in non-cardiac chest pain: a metaanalysis. Am. J. Gastroenterol. 2005; 100(6): 1226–32. DOI: 10.1111/j.1572-0241.2005.41657.x
5. Kahrilas P.J., Hughes N., Howden C.W. Response of unexplained chest pain to proton pump inhibitor treatment in patients with and without objective evidence of gastro-oesophageal reflux disease. Gut. 2011; 60(11): 1473–8. DOI: 10.1136/gut.2011.241307
6. Lundell L.R., Dent J., Bennett J.R., Blum A.L. et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999; 45(2): 172–80. DOI: 10.1136/gut.45.2.172
7. Gyawali C.P., Fass R. Management of gastroesophageal reflux disease. Gastroenterology. 2018; 154(2): 302–18. DOI: 10.1053/j.gastro.2017.07.049
8. Dunbar K.B., Agoston A.T., Odze R.D., Huo X. et al. Association of acute gastroesophageal reflux disease with esophageal histologic changes. JAMA. 2016; 315(19): 2104–12. DOI: 10.1001/jama.2016.5657
9. Odiase E., Schwartz A., Souza R.F., Martin J. et al. New eosinophilic esophagitis concepts call for change in proton pump inhibitor management before diagnostic endoscopy. Gastroenterology. 2018; 154(5): 1217–21.e3. DOI: 10.1053/j.gastro.2018.03.003
10. Stoikes N., Drapekin J., Kushnir V., Shaker A. et al. The value of multiple rapid swallows during preoperative esophageal manometry before laparoscopic antireflux surgery. Surg. Endosc. 2012; 26(12): 3401–7. DOI: 10.1007/s00464-012-2350-0
11. Kaltenbach T., Crockett S., Gerson L.B. Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. Arch. Intern. Med. 2006; 166(9): 965–71. DOI: 10.1001/archinte.166.9.965
12. Khoury R.M., Camacho-Lobato L., Katz P.O., Mohiuddin M.A. et al. Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with gastroesophageal reflux disease. Am. J. Gastroenterol. 1999; 94(8): 2069–73. DOI: 10.1111/j.1572-0241.1999.01279.x
13. Allampati S., Lopez R., Thota P.N., Ray M. et al. Use of a positional therapy device significantly improves nocturnal gastroesophageal reflux symptoms. Dis. Esophagus. 2017; 30(3): 1–7. DOI: 10.1111/dote.12495
14. Person E., Rife C., Freeman J., Clark A. et al. A novel sleep positioning device reduces gastroesophageal reflux: a randomized controlled trial. J. Clin. Gastroenterol. 2015; 49(8): 655–9. DOI: 10.1097/MCG.0000000000000359
15. Newberry C., Lynch K. The role of diet in the development and management of gastroesophageal reflux disease: why we feel the burn. J. Thorac. Dis. 2019; 11(suppl.12): S1594–601. DOI: 10.21037/jtd.2019.06.42
16. Ness-Jensen E., Lindam A., Lagergren J., Hveem K. Tobacco smoking cessation and improved gastroesophageal reflux: a prospective population-based cohort study: the HUNT study. Am. J. Gastroenterol. 2014; 109(2): 171–7. DOI: 10.1038/ajg.2013.414
17. Kohata Y., Fujiwara Y., Watanabe T., Kobayashi M. et al. Longterm benefits of smoking cessation on gastroesophageal reflux disease and health-related quality of life. PLoS One. 2016; 11(2): e0147860. DOI: 10.1371/journal.pone.0147860
18. Wang W.H., Huang J.Q., Zheng G.F., Xia H.H. et al. Head-to-head comparison of H2-receptor antagonists and proton pump inhibitors in the treatment of erosive esophagitis: a meta-analysis. World J. Gastroenterol. 2005; 11(26): 4067–77. DOI: 10.3748/wjg.v11.i26.4067
19. Khan M., Santana J., Donnellan C., Preston C. et al. Medical treatments in the short term management of reflux oesophagitis. Cochrane Database Syst. Rev. 2007; 2: CD003244. DOI: 10.1002/14651858.CD003244.pub2
20. Hatlebakk J.G., Berstad A. Pharmacokinetic optimisation in the treatment of gastro-oesophageal reflux disease. Clin. Pharmacokinet. 1996; 31(5): 386–406. DOI: 10.2165/00003088-199631050-00005
21. Lee R.D., Mulford D., Wu J., Atkinson S.N. The effect of time-ofday dosing on the pharmacokinetics and pharmacodynamics of dexlansoprazole MR: evidence for dosing flexibility with a Dual Delayed Release proton pump inhibitor. Aliment. Pharmacol. Ther. 2010; 31(9): 1001–11. DOI: 10.1111/j.1365-2036.2010.04272.x
22. Gunaratnam N.T., Jessup T.P., Inadomi J., Lascewski D.P. Suboptimal proton pump inhibitor dosing is prevalent in patients with poorly controlled gastro-oesophageal reflux disease. Aliment. Pharmacol. Ther. 2006; 23(10): 1473–7. DOI: 10.1111/j.1365-2036.2006.02911.x
23. Savarino V., Marabotto E., Zentilin P., Furnari M. et al. Pathophysiology, diagnosis, and pharmacological treatment of gastro-esophageal reflux disease. Expert Rev. Clin. Pharmacol. 2020; 13(4): 437–49. DOI: 10.1080/17512433.2020.1752664
24. Boghossian T.A., Rashid F.J., Thompson W., Welch V. et al. Deprescribing versus continuation of chronic proton pump inhibitor use in adults. Cochrane Database Syst. Rev. 2017; 3(3): CD011969. DOI: 10.1002/14651858.CD011969.pub2
25. Talley N.J., Lauritsen K., Tunturi-Hihnala H., Lind T. et al. Esomeprazole 20 mg maintains symptom control in endoscopynegative gastro-oesophageal reflux disease: a controlled trial of 'on-demand' therapy for 6 months. Aliment. Pharmacol. Ther. 2001; 15(3): 347–54. DOI: 10.1046/j.1365-2036.2001.00943.x
26. Schindlbeck N.E., Klauser A.G., Berghammer G., Londong W. et al. Three year follow up of patients with gastrooesophageal reflux disease. Gut. 1992; 33(8): 1016–9. DOI: 10.1136/gut.33.8.1016
27. Lind T., Havelund T., Lundell L., Glise H. et al. On demand therapy with omeprazole for the long-term management of patients with heartburn without oesophagitis — a placebo-controlled randomized trial. Aliment. Pharmacol. Ther. 1999; 13(7): 907–14. DOI: 10.1046/j.1365-2036.1999.00564.x
28. Pace F., Tonini M., Pallotta S., Molteni P. et al. Systematic review: maintenance treatment of gastro-oesophageal reflux disease with proton pump inhibitors taken 'on-demand'. Aliment. Pharmacol. Ther. 2007; 26(2): 195–204. DOI: 10.1111/j.1365-2036.2007.03381.x
29. Inadomi J.M., Jamal R., Murata G.H., Hoffman R.M. et al. Step-down management of gastroesophageal reflux disease. Gastroenterology. 2001; 121(5): 1095–100. DOI: 10.1053/gast.2001.28649
30. Juul-Hansen P., Rydning A. Clinical and pathophysiological consequences of on-demand treatment with PPI in endoscopynegative reflux disease. Is rebound hypersecretion of acid a problem? Scand. J. Gastroenterol. 2011; 46(4): 398–405. DOI: 10.3109/00365521.2010.537684
31. Metz D.C., Pilmer B.L., Han C., Perez M.C. Withdrawing PPI therapy after healing esophagitis does not worsen symptoms or cause persistent hypergastrinemia: analysis of dexlansoprazole MR clinical trial data. Am. J. Gastroenterol. 2011; 106(11): 1953–60. DOI: 10.1038/ajg.2011.220
32. Tsukanov V.V., Butorin N.N., Maady A.S., Shtygasheva O.V. et al. Helicobacter pylori infection, intestinal metaplasia, and gastric cancer risk in Eastern Siberia. Helicobacter. 2011; 16(2): 107–12. DOI: 10.1111/j.1523-5378.2011.00827.x
33. Tsukanov V.V., Kasparov E.V., Tonkikh J.L., Shtygasheva O.V. et al. Peptic ulcer disease and Helicobacter pylori infection in different Siberian ethnicities. Helicobacter. 2017; 22(1): e12322. DOI: 10.1111/hel.12322
Review
For citations:
Tsukanov V.V., Vasyutin A.V., Tonkikh Yu.L. Current International Guidelines for the Management of Patients with Gastroesophageal Reflux Disease: Diagnosis and Management of Typical Syndromes. Title. 2022;21(6):29-34. (In Russ.) https://doi.org/10.31550/1727-2378-2022-21-6-29-34
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