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Surgical Endoscopy
Published in: Surgical Endoscopy 2/2023

18-12-2022 | Obesity | Guidelines

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

Authors: 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 Krishnan, Anne Lidor, Virginia Litle, Donald Low, Anthony Petrick, Ian S. Soriano, Nirav Thosani, Amy Tyberg, Vic Velanovich, Ramon Vilallonga, Jeffrey M. Marks

Published in: Surgical Endoscopy | Issue 2/2023

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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.
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Metadata
Title
Multi-society consensus conference and guideline on the treatment of gastroesophageal reflux disease (GERD)
Authors
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 Krishnan
Anne Lidor
Virginia Litle
Donald Low
Anthony Petrick
Ian S. Soriano
Nirav Thosani
Amy Tyberg
Vic Velanovich
Ramon Vilallonga
Jeffrey M. Marks
Publication date
18-12-2022
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 2/2023
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-022-09817-3

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