An evidence-based appraisal of reflux disease management --- the Genval Workshop Report

Dent, John; Brun, J; Fendrick, A. Mark; Fennerty, M. Brian; Janssens, Jozef; Kahrilas, Peter J.; Lauritsen, K; Reynolds, James C.; Shaw, Michael; Talley, Nicholas J.

doi:10.1136/gut.44.2008.s1

Cited by 769 publications

(725 citation statements)

References 112 publications

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“…3 Best outcomes are achieved with these aims by the use of a proton pump inhibitor. The increment of efficacy of esomeprazole over other proton pump inhibitors further enhances the opportunities for achieving excellent results in this first phase of reflux disease management.…”

Section: Discussionmentioning

confidence: 99%

“…Fortunately, reflux-induced symptoms are quite distinctive in their patterning in a substantial majority of patients with reflux disease, as other diagnostic options are unsuitable for routine initial management ) endoscopy being relatively insensitive and oesophageal pH-monitoring being impractical as a Ôfront-lineÕ test. 3 Both of these diagnostic tests are also relatively costly and frequently difficult to access promptly. As initial therapy is usually prescribed on the basis of symptom evaluation, relief of symptoms by therapy is the best possible confirmation of this diagnosis.…”

Section: Aims Of Initial Treatmentmentioning

confidence: 99%

“…As initial therapy is usually prescribed on the basis of symptom evaluation, relief of symptoms by therapy is the best possible confirmation of this diagnosis. Antacids and lifestyle/postural measures give poor symptom response rates; 3 consequently, use of these as initial therapy will usually leave uncertainty as to whether the diagnosis was correct. H 2 -receptor antagonists (H 2 RAs) are a better option for diagnostic confirmation, but the substantially superior symptom response with proton pump inhibitor therapy gives the best chance of a crisp Ôfirst-shotÕ confirmation of reflux disease by relief of symptoms.…”

Section: Aims Of Initial Treatmentmentioning

confidence: 99%

“…[1][2][3] When a review of symptoms confirms that these are typical for reflux disease, initial therapy should be intensified. If a proton pump inhibitor has not yet been used, this should be prescribed as it is by far the most effective intensification of therapy.…”

Section: What To Do If Initial Treatment Failsmentioning

confidence: 99%

“…3 This knowledge has led to consensus groups advocating a trial off therapy in all patients with uninvestigated symptomatic reflux disease treated with initial gastric acid suppression; if symptoms recur, a long-term management strategy will usually be needed.…”

Section: Disease Severity and Outcomementioning

confidence: 99%

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Overview: initial and long‐term management of gastro‐oesophageal reflux disease

Talley

2003

Aliment Pharmacol Ther

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Summary Initial management of gastro‐oesophageal reflux disease aims to confirm a symptom‐based diagnosis, to relieve symptoms, to reassure the patient as to the treatable nature of reflux disease, and to initiate risk management and healing of oesophagitis. The aims of long‐term management include adequate control of symptoms, prevention of complications, and improvement of quality of life. Management options in terms of use of proton pump inhibitors are either daily therapy (maintenance), intermittent courses of therapy (for example, 4 weeks, then cease and observe), or on‐demand therapy. This overview discusses the advantages and disadvantages of these different strategies for the management of reflux disease.

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Section: Discussionmentioning

confidence: 99%

Section: Aims Of Initial Treatmentmentioning

confidence: 99%

Section: Aims Of Initial Treatmentmentioning

confidence: 99%

Section: What To Do If Initial Treatment Failsmentioning

confidence: 99%

Section: Disease Severity and Outcomementioning

confidence: 99%

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Overview: initial and long‐term management of gastro‐oesophageal reflux disease

Talley

2003

Aliment Pharmacol Ther

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Are Lifestyle Measures Effective in Patients With Gastroesophageal Reflux Disease?

2006

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ifestyle modifications are first-line therapy for patients with gastroesophageal reflux disease (GERD). We applied an evidence-based approach to determine the efficacy of lifestyle measures for GERD management. We used PubMed and Ovid to perform a search of the literature published between 1975 and 2004 using the key words heartburn, GERD, smoking, alcohol, obesity, weight loss, caffeine or coffee, citrus, chocolate, spicy food, head of bed elevation, and late-evening meal. Each study was reviewed by 2 reviewers who assigned one of the following ratings: evidence A, randomized clinical trials; evidence B, cohort or case-control studies; evidence C, case reports or flawed clinical trials; evidence D, investigator experience; or evidence E, insufficient information. We screened 2039 studies and identified 100 that were relevant. Only 16 clinical trials examined the impact on GERD (by change in symptoms, esophageal pH variables, or lower esophageal sphincter pressure) of the lifestyle measure. Although there was physiologic evidence that exposure to tobacco, alcohol, chocolate, and high-fat meals decreases lower esophageal sphincter pressure, there was no published evidence of the efficacy of dietary measures. Neither tobacco nor alcohol cessation was associated with improvement in esophageal pH profiles or symptoms (evidence B). Head of bed elevation and left lateral decubitus position improved the overall time that the esophageal pH was less than 4.0 (evidence B). Weight loss improved pH profiles and symptoms (evidence B). Weight loss and head of bed elevation are effective lifestyle interventions for GERD. There is no evidence supporting an improvement in GERD measures after cessation of tobacco, alcohol, or other dietary interventions.

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