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Jake Keator
January 7, 2022

In November 2021, the ACG presented updated guidelines regarding the treatment of gastroesophageal reflux disease, also known as GERD. These changes utilized the latest research to assist physicians in providing the safest and highest quality care to their patients.

“The ethos of the new GERD guidelines is to synthesize the highest quality, yet still practical, recommendations for the diagnosis and management of patients with GERD,” Philip O. Katz, MD, MACG, professor of medicine at Weill Cornell Medicine in New York City, told Healio Gastroenterology. They have been developed for the clinician to enhance their opportunity to provide the best possible evidence-based patient care, using the full menu of diagnostic tests and therapeutic interventions for these often-complex patients. We hope you find them useful in your everyday practice.”

Some updated recommendations included avoiding trigger foods, avoiding smoking and tobacco products, not eating within two to three hours prior to going to bed, and recommending weight loss in overweight and obese patients.

Other recommendations included:

  • Objective testing for patients who experience chest pains without heartburn and have not been assessed for heart disease.
  • Using barium swallow alone is no longer recommended as a diagnostic test for GERD.
  • Endoscopy is now the first test recommended for patients with dysphagia or other major symptoms and those with Barrett’s esophagus.
  • For patients with no alarming symptoms, but who suffer from heartburn and regurgitation, an 8-week trial of empiric proton pump inhibitors (PPI’s) is recommended. Should the patient respond to the trial, physicians should consider stopping the PPI’s.
  • PPI’s should be used for treatment rather than histamine-2 receptor antagonists.
  • Two to four weeks following stopping PPI’s a diagnostic endoscopy should be performed on patients whose typical GERD symptoms did not respond to PPI’s.
  • PPI’s should now be administered 30-60 minutes before a meal instead of immediately before bed.
  • Baclofen is no longer recommended in those without GERD symptoms. A prokinetic agent is also not recommended without evidence of gastroparesis. It is also no longer recommended that pregnant patients take sucralfate.

For information for patients regarding GERD, read our “Understanding GERD” article by clicking here.

To view the full article from Healio Gastroenterology click here.