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. 2024 Jan 1;36(1):13-25.
doi: 10.1097/MEG.0000000000002682.

Management advice for patients with reflux-like symptoms: an evidence-based consensus

A Pali Hungin  1 , Rena Yadlapati  2 , Foteini Anastasiou  3 , Albert J Bredenoord  4 , Hashem El Serag  5 , Pierluigi Fracasso  6 , Juan M Mendive  7 , Edoardo V Savarino  8 , Daniel Sifrim  9 , Mihaela Udrescu  10 , Peter J Kahrilas  11
Affiliations

Management advice for patients with reflux-like symptoms: an evidence-based consensus

A Pali Hungin et al. Eur J Gastroenterol Hepatol. .

Abstract

Patients with reflux-like symptoms (heartburn and regurgitation) are often not well advised on implementing individualised strategies to help control their symptoms using dietary changes, lifestyle modifications, behavioural changes or fast-acting rescue therapies. One reason for this may be the lack of emphasis in management guidelines owing to 'low-quality' evidence and a paucity of interventional studies. Thus, a panel of 11 gastroenterologists and primary care doctors used the Delphi method to develop consolidated advice for patients based on expert consensus. A steering committee selected topics for literature searches using the PubMed database, and a modified Delphi process including two online meetings and two rounds of voting was conducted to generate consensus statements based on prespecified criteria (67% voting 'strongly agree' or 'agree with minor reservation'). After expert discussion and two rounds of voting, 21 consensus statements were generated, and assigned strength of evidence and Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) rating. Eleven statements achieved the strongest (100%) agreement: five are related to diet and include identification and avoidance of dietary triggers, limiting alcohol, coffee and carbonated beverages, and advising patients troubled by postprandial symptoms not to overeat; the remaining six statements concern advice around smoking cessation, weight loss, raising the head-of-the-bed, avoiding recumbency after meals, stress reduction and alginate use. The aim of developing the consensus statements is that they may serve as a foundation for tools and advice that can routinely help patients with reflux-like symptoms better understand the causes of their symptoms and manage their individual risk factors and triggers.

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Conflict of interest statement

All authors attended the online meetings funded by Reckitt Benckiser Healthcare Ltd. A.P.H. has served as a consultant for Sandoz and Tillotts, and Chair of Rome IV Primary Care Committee. R.Y. has served as a consultant for Medtronic, Phathom Pharmaceuticals, StatLinkMD, and Medscape, has received research support from Ironwood Pharmaceuticals and is on the advisory board with stock options for RJS Mediagnostix. F.A. is a member of the Programme for NASH in Primary Health Care at the University of Crete, funded by Gilead. A.B. has received research funding from Nutricia, Norgine, Dr Falk Pharma, Thelial, and SST and received speaker and/or consulting fees from Laborie, Medtronic, Dr Falk Pharma, Reckitt, Alimentiv, Sanofi/Regeneron and AstraZeneca. H.E. has received research funding from Phathom. P.F. has received conference fees from Schwabe Pharma. J.M.M. has participated in educational activities funded by Reckitt Benckiser Healthcare Ltd. E.V.S. has served as speaker for Abbvie, Agave, AGPharma, Alfasigma, Aurora Pharma, CaDiGroup, Celltrion, Dr Falk Pharma, for example, Stada Group, Fenix Pharma, Fresenius Kabi, Galapagos, Janssen, JB Pharmaceuticals, Innovamedica/Adacyte, Malesci, Mayoly Biohealth, Omega Pharma, Pfizer, Reckitt Benckiser, Sandoz, SILA, Sofar, Takeda, Tillots, Unifarco; has served as a consultant for Abbvie, Agave, Alfasigma, Biogen, Bristol-Myers Squibb, Celltrion, Diadema Farmaceutici, Dr Falk Pharma, Fenix Pharma, Fresenius Kabi, Janssen, JB Pharmaceuticals, Merck & Co, Reckitt Benckiser, Regeneron, Sanofi, SILA, Sofar, Synformulas GmbH, Takeda, Unifarco; he received research support from Pfizer, Reckitt Benckiser, SILA, Sofar, Unifarco, Zeta Farmaceutici. D.S. has received research grants from Reckitt Benckiser Healthcare Ltd, Jinshan Technology (China), and Alfa Sigma (Italy). M.U. has served as speaker for Sanofi, Terapia, Servier, Berlin-Chemie, Ipsen, Bayer, Abbvie. P.J.K. has served as a consultant for Ironwood and Reckitt.

Figures

Fig. 1.
Fig. 1.
Consensus procedure flow chart. †Pilot statements and revisions are listed in Supplemental digital content 1, http://links.lww.com/EJGH/A950.
Fig. 2.
Fig. 2.
Breakdown of voting agreement for statements regarding diet and exercise advice for reflux-like symptoms.
Fig. 3.
Fig. 3.
Breakdown of voting agreement for statements regarding lifestyle and behaviour advice for reflux-like symptoms.
Fig. 4.
Fig. 4.
Breakdown of voting agreement for statements concerning other interventions to target reflux-like symptom pathophysiology.
See this image and copyright information in PMC

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