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

Bethany J. Slater, Amelia Collings, Rebecca Dirks, Jon C. Gould, Alia P. Qureshi, Ryan Juza, María Rita Rodríguez-Luna, Claire Wunker, Geoffrey P. Kohn, Shanu Kothari, Elizabeth Carslon, Stephanie Worrell, Ahmed M. Abou-Setta, Mohammed T. Ansari, Dimitrios I. Athanasiadis, Shaun Daly, Francesca Dimou, Ivy N. Haskins, Julie Hong, Kumar KrishnanAnne Lidor, Virginia Litle, Donald Low, Anthony Petrick, Ian S. Soriano, Nirav Thosani, Amy Tyberg, Vic Velanovich, Ramon Vilallonga, Jeffrey M. Marks

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

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.

Original languageEnglish
Pages (from-to)781-806
Number of pages26
JournalSurgical endoscopy
Volume37
Issue number2
DOIs
StatePublished - Feb 2023

Keywords

  • Antireflux surgery
  • Fundoplication
  • GERD
  • Gastroesophageal reflux
  • Obesity
  • Proton pump inhibitor

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