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Management options for patients with GERD and persistent symptoms on proton pump inhibitors: recommendations from an expert panel.
Yadlapati, Rena; Vaezi, Michael F; Vela, Marcelo F; Spechler, Stuart J; Shaheen, Nicholas J; Richter, Joel; Lacy, Brian E; Katzka, David; Katz, Philip O; Kahrilas, Peter J; Gyawali, Prakash C; Gerson, Lauren; Fass, Ronnie; Castell, Donald O; Craft, Jenna; Hillman, Luke; Pandolfino, John E.
Afiliação
  • Yadlapati R; Anschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hi
  • Vaezi MF; Anschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hi
  • Vela MF; Anschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hi
  • Spechler SJ; Anschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hi
  • Shaheen NJ; Anschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hi
  • Richter J; Anschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hi
  • Lacy BE; Anschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hi
  • Katzka D; Anschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hi
  • Katz PO; Anschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hi
  • Kahrilas PJ; Anschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hi
  • Gyawali PC; Anschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hi
  • Gerson L; Anschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hi
  • Fass R; Anschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hi
  • Castell DO; Anschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hi
  • Craft J; Anschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hi
  • Hillman L; Anschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hi
  • Pandolfino JE; Anschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hi
Am J Gastroenterol ; 113(7): 980-986, 2018 07.
Article em En | MEDLINE | ID: mdl-29686276
ABSTRACT

BACKGROUND:

The aim of this study was to assess expert gastroenterologists' opinion on treatment for distinct gastroesophageal reflux disease (GERD) profiles characterized by proton pump inhibitor (PPI) unresponsive symptoms.

METHODS:

Fourteen esophagologists applied the RAND/UCLA Appropriateness Method to hypothetical scenarios with previously demonstrated GERD (positive pH-metry or endoscopy) and persistent symptoms despite double-dose PPI therapy undergoing pH-impedance monitoring on therapy. A priori thresholds included esophageal acid exposure (EAE) time >6.0%; symptom-reflux association symptom index >50% and symptom association probability >95%; >80 reflux events; large hiatal hernia >3 cm. Primary outcomes were appropriateness of four invasive procedures (laparoscopic fundoplication, magnetic sphincter augmentation, transoral incisionless fundoplication, radiofrequency energy delivery) and preference for pharmacologic/behavioral therapy.

RESULTS:

Laparoscopic fundoplication was deemed appropriate for elevated EAE, and moderately appropriate for positive symptom-reflux association for regurgitation and a large hiatal hernia with normal EAE. Magnetic sphincter augmentation was deemed moderately appropriate for elevated EAE without a large hiatal hernia. Transoral incisionless fundoplication and radiofrequency energy delivery were not judged appropriate in any scenario. Preference for non-invasive options was as follows H2RA for elevated EAE, transient lower esophageal sphincter relaxation inhibitors for elevated reflux episodes, and neuromodulation/behavioral therapy for positive symptom-reflux association.

CONCLUSION:

For treatment of PPI unresponsive symptoms in proven GERD, expert esophagologists recommend invasive therapy only in the presence of abnormal reflux burden, with or without hiatal hernia, or regurgitation with positive symptom-reflux association and a large hiatus hernia. Non-invasive pharmacologic or behavioral therapies are preferred for all other scenarios.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Padrões de Prática Médica / Refluxo Gastroesofágico / Inibidores da Bomba de Prótons Tipo de estudo: Diagnostic_studies / Guideline / Observational_studies / Prognostic_studies Limite: Female / Humans / Male / Middle aged País como assunto: America do norte Idioma: En Ano de publicação: 2018 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Padrões de Prática Médica / Refluxo Gastroesofágico / Inibidores da Bomba de Prótons Tipo de estudo: Diagnostic_studies / Guideline / Observational_studies / Prognostic_studies Limite: Female / Humans / Male / Middle aged País como assunto: America do norte Idioma: En Ano de publicação: 2018 Tipo de documento: Article