Latin American consensus on diagnosis of gastroesophageal reflux disease

Journal
Neurogastroenterology & Motility
ISSN
1350-1925
1365-2982
Date Issued
2024
Author(s)
Jorge A. Olmos
John E. Pandolfino
María M. Piskorz
Natalia Zamora
Miguel A. Valdovinos Díaz
José M. Remes Troche
Mauricio Guzmán
Albis Hani
Luis R. Valdovinos García
Hannah Pitanga Lukashok
Gerson Domingues
Eduardo Vesco
Mariel Mejia Rivas
Luis F. Pineda Ovalle
DANIEL IGNACIO CISTERNAS RODRIGUEZ
Marcelo F. Vela
Type
journal-article
DOI
URL
Abstract
<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Diagnosing gastroesophageal reflux disease (GERD) can be challenging given varying symptom presentations, and complex multifactorial pathophysiology. The gold standard for GERD diagnosis is esophageal acid exposure time (AET) measured by pH‐metry. A variety of additional diagnostic tools are available. The goal of this consensus was to assess the individual merits of GERD diagnostic tools based on current evidence, and provide consensus recommendations following discussion and voting by experts.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This consensus was developed by 15 experts from nine countries, based on a systematic search of the literature, using GRADE (grading of recommendations, assessment, development and evaluation) methodology to assess the quality and strength of the evidence, and provide recommendations regarding the diagnostic utility of different GERD diagnosis tools, using AET as the reference standard.</jats:p></jats:sec><jats:sec><jats:title>Key Results</jats:title><jats:p>A proton pump inhibitor (PPI) trial is appropriate for patients with heartburn and no alarm symptoms, but nor for patients with regurgitation, chest pain, or extraesophageal presentations. Severe erosive esophagitis and abnormal reflux monitoring off PPI are clearly indicative of GERD. Esophagram, esophageal biopsies, laryngoscopy, and pharyngeal pH monitoring are not recommended to diagnose GERD. Patients with PPI‐refractory symptoms and normal endoscopy require reflux monitoring by pH or pH‐impedance to confirm or exclude GERD, and identify treatment failure mechanisms. GERD confounders need to be considered in some patients, pH‐impedance can identify supragrastric belching, impedance‐manometry can diagnose rumination.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Erosive esophagitis on endoscopy and abnormal pH or pH‐impedance monitoring are the most appropriate methods to establish a diagnosis of GERD. Other tools may add useful complementary information.</jats:p></jats:sec>