Multi-society consensus conference and guideline on the treatment of gastroesophageal reflux disease (GERD)

Bethany J Slater¹, Amelia Collings², Rebecca Dirks², Jon C Gould³, Alia P Qureshi⁴, Ryan Juza⁵, María Rita Rodríguez-Luna⁶, Claire Wunker⁷, Geoffrey P Kohn⁸, Shanu Kothari⁹, Elizabeth Carslon¹⁰, Stephanie Worrell¹¹, Ahmed M Abou-Setta¹², Mohammed T Ansari¹³, Dimitrios I Athanasiadis², Shaun Daly¹⁴, Francesca Dimou¹⁵, Ivy N Haskins¹⁶, Julie Hong¹⁷, Kumar Krishnan¹⁸, Anne Lidor⁵, Virginia Litle¹⁹, Donald Low¹⁰, Anthony Petrick²⁰, Ian S Soriano²¹, Nirav Thosani²², Amy Tyberg²³, Vic Velanovich²⁴, Ramon Vilallonga²⁵, Jeffrey M Marks²⁶

Affiliations

¹ University of Chicago Medicine, 5841 S. Maryland Avenue, MC 4062, Chicago, IL, USA. bjslater1@gmail.com.
² Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
³ Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
⁴ Division of General & GI Surgery, Foregut Surgery, Oregon Health & Science University, Portland, OR, USA.
⁵ Department of Surgery, University of Wisconsin, Madison, WI, USA.
⁶ Research Institute Against Digestive Cancer (IRCAD) and ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France.
⁷ Saint Louis University, St Louis, MO, USA.
⁸ Department of Surgery, Monash University, Melbourne, VIC, Australia.
⁹ Department of Surgery, Prisma Health, Greenville, SC, USA.
¹⁰ Virginia Mason Medical Center, Seattle, WA, USA.
¹¹ University of Arizona Health Sciences, Tucson, AZ, USA.
¹² Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
¹³ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
¹⁴ Department of Surgery, University of California, Irvine, Orange, CA, USA.
¹⁵ Washington University in St. Louis, St. Louis, MO, USA.
¹⁶ Department of Surgery, University of Nebraska Medical Center, Omaha, USA.
¹⁷ Department of Surgery, New York Presbyterian/Queens, Queens, USA.
¹⁸ Massachusetts General Hospital, Boston, MA, USA.
¹⁹ Section of Thoracic Surgery, Department of Cardiovascular Surgery, Intermountain Healthcare, Salt Lake City, UT, USA.
²⁰ Department of General Surgery, Geisinger School of Medicine, Geisinger Medical Center, Danville, PA, USA.
²¹ Department of Surgery, University of California San Francisco School of Medicine, San Francisco, CA, USA.
²² McGovern Medical School, Center for Interventional Gastroenterology at UTHealth, Houston, TX, USA.
²³ Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
²⁴ Division of Gastrointestinal Surgery, Tampa General, Tampa, FL, USA.
²⁵ Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain.
²⁶ Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.

PMID: 36529851
DOI: 10.1007/s00464-022-09817-3

Multi-society consensus conference and guideline on the treatment of gastroesophageal reflux disease (GERD)

Bethany J Slater et al. Surg Endosc. 2023 Feb.

. 2023 Feb;37(2):781-806.

doi: 10.1007/s00464-022-09817-3. Epub 2022 Dec 18.

Authors

Affiliations

¹ University of Chicago Medicine, 5841 S. Maryland Avenue, MC 4062, Chicago, IL, USA. bjslater1@gmail.com.
² Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
³ Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
⁴ Division of General & GI Surgery, Foregut Surgery, Oregon Health & Science University, Portland, OR, USA.
⁵ Department of Surgery, University of Wisconsin, Madison, WI, USA.
⁶ Research Institute Against Digestive Cancer (IRCAD) and ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France.
⁷ Saint Louis University, St Louis, MO, USA.
⁸ Department of Surgery, Monash University, Melbourne, VIC, Australia.
⁹ Department of Surgery, Prisma Health, Greenville, SC, USA.
¹⁰ Virginia Mason Medical Center, Seattle, WA, USA.
¹¹ University of Arizona Health Sciences, Tucson, AZ, USA.
¹² Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
¹³ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
¹⁴ Department of Surgery, University of California, Irvine, Orange, CA, USA.
¹⁵ Washington University in St. Louis, St. Louis, MO, USA.
¹⁶ Department of Surgery, University of Nebraska Medical Center, Omaha, USA.
¹⁷ Department of Surgery, New York Presbyterian/Queens, Queens, USA.
¹⁸ Massachusetts General Hospital, Boston, MA, USA.
¹⁹ Section of Thoracic Surgery, Department of Cardiovascular Surgery, Intermountain Healthcare, Salt Lake City, UT, USA.
²⁰ Department of General Surgery, Geisinger School of Medicine, Geisinger Medical Center, Danville, PA, USA.
²¹ Department of Surgery, University of California San Francisco School of Medicine, San Francisco, CA, USA.
²² McGovern Medical School, Center for Interventional Gastroenterology at UTHealth, Houston, TX, USA.
²³ Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
²⁴ Division of Gastrointestinal Surgery, Tampa General, Tampa, FL, USA.
²⁵ Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain.
²⁶ Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.

PMID: 36529851
DOI: 10.1007/s00464-022-09817-3

Abstract

Background: Gastroesophageal reflux disease (GERD) is one of the most common diseases in North America and globally. The aim of this guideline is to provide evidence-based recommendations regarding the most utilized and available endoscopic and surgical treatments for GERD.

Methods: Systematic literature reviews were conducted for 4 key questions regarding the surgical and endoscopic treatments for GERD in adults: preoperative evaluation, endoscopic vs surgical or medical treatment, complete vs partial fundoplication, and treatment for obesity (body mass index [BMI] ≥ 35 kg/m²) and concomitant GERD. Evidence-based recommendations were formulated using the GRADE methodology by subject experts. Recommendations for future research were also proposed.

Results: The consensus provided 13 recommendations. Through the development of these evidence-based recommendations, an algorithm was proposed for aid in the treatment of GERD. Patients with typical symptoms should undergo upper endoscopy, manometry, and pH-testing; additional testing may be required for patients with atypical or extra-esophageal symptoms. Patients with normal or abnormal findings on manometry should consider undergoing partial fundoplication. Magnetic sphincter augmentation or fundoplication are appropriate surgical procedures for adults with GERD. For patients who wish to avoid surgery, the Stretta procedure and transoral incisionless fundoplication (TIF 2.0) were found to have better outcomes than proton pump inhibitors alone. Patients with concomitant obesity were recommended to undergo either gastric bypass or fundoplication, although patients with severe comorbid disease or BMI > 50 should undergo Roux-en-Y gastric bypass for the additional benefits that follow weight loss.

Conclusion: Using the recommendations an algorithm was developed by this panel, so that physicians may better counsel their patients with GERD. There are certain patient factors that have been excluded from included studies/trials, and so these recommendations should not replace surgeon-patient decision making. Engaging in the identified research areas may improve future care for GERD patients.

Keywords: Antireflux surgery; Fundoplication; GERD; Gastroesophageal reflux; Obesity; Proton pump inhibitor.

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Comment in

Commentary on the Multi-society Consensus Conference and Guideline on the Treatment of Gastroesophageal Reflux Disease (GERD).
Dimou FM, Lidor A, Velanovich V. Dimou FM, et al. J Gastrointest Surg. 2023 Mar;27(3):650-652. doi: 10.1007/s11605-023-05613-z. Epub 2023 Jan 31. J Gastrointest Surg. 2023. PMID: 36720755 No abstract available.

References

1. Andrews JC, Schünemann HJ, Oxman AD, Pottie K, Meerpohl JJ, Coello PA, Rind D, Montori VM, Brito JP, Norris S, Elbarbary M, Post P, Nasser M, Shukla V, Jaeschke R, Brozek J, Djulbegovic B, Guyatt G (2013) GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation’s direction and strength. J Clin Epidemiol 66:726–735 - PubMed - DOI
1. Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Global Consensus Group (2006) The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 101:1900–1920 (quiz 1943) - PubMed - DOI
1. Sandhu DS, Fass R (2018) Current trends in the management of gastroesophageal reflux disease. Gut Liver 12:7–16 - PubMed - DOI
1. El-Serag HB, Sweet S, Winchester CC, Dent J (2014) Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 63:871–880 - PubMed - DOI
1. Thong BKS, Ima-Nirwana S, Chin KY (2019) Proton pump inhibitors and fracture risk: a review of current evidence and mechanisms involved. Int J Environ Res Public Health 16:1571 - PubMed - PMC - DOI

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Multi-society consensus conference and guideline on the treatment of gastroesophageal reflux disease (GERD)

Affiliations

Multi-society consensus conference and guideline on the treatment of gastroesophageal reflux disease (GERD)

Authors

Affiliations

Abstract

Comment in

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Research Materials