AGA report on gastroesophageal reflux disease - American Gastroenterological Association

Author: Carrie Morantz, Brian Torrey
Date: Sept 15, 2003

A consensus development panel of the American Gastroenterological Association (AGA) has issued recommendations on the management of gastroesophageal reflux disease (GERD). The monograph "Improving the Management of GERD: Evidence-Based Therapeutic Strategies" is available online at monograph.pdf.

The panel reviewed data on over-the-counter drugs used to treat symptoms of GERD and concluded that all products have been proved effective, to varying degrees, in relieving mild to moderate GERD when compared with placebo. A review of randomized controlled trials (RCTs) that compared two or more proton pump inhibitors found minimal clinical differences between the drugs. Omeprazole, lansoprazole, pantoprazole, and rabeprazole all produce comparable rates of healing and remission in patients with erosive esophagitis.

The panel found that the incidence of adenocarcinoma in patients with Barrett's esophagus is about 0.5 percent per year, rather than the previously thought rate of 1 to 2 percent per year. Although nearly all esophageal adenocarcinomas occur in patients with Barrett's esophagus, most patients with this condition will never develop this tumor, especially if the extent of metaplasia is less than 3 cm.

It was thought that surgical fundoplication can prevent esophageal cancer by preventing acid reflux. However, data show that the rate of esophageal cancer is similar in patients who are treated surgically and those who are not.

Use of two new endoscopic procedures for treating GERD is increasing despite a lack of data about their efficacy. The panel found that there is currently no adequate data from RCTs to support endoscopic/intraluminal therapies. Physicians and the public should be educated about the risks and limitations of these therapies.

Epidemiologic studies consistently show modest but significant associations between pulmonary symptoms such as asthma and cough, but there is insufficient data to infer a causal relationship. There is evidence that GERD therapy can improve symptoms, however, lung function tests do not improve.

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