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American Gastroenterological Association panel reaches consensus on GERD management strategies.
A panel of experts appointed by the American Gastroenterological Association (AGA) has reached consensus on the most effective and appropriate treatments for gastroesophageal reflux disease (GERD). This is the first time AGA has issued such recommendations. It is estimated that there are 61 million patients in the United States who are struggling to control their symptoms of GERD.
Among the panel's conclusions are the following:
The panel reviewed data on over-the-counter (OTC) products, concluding that, to a varying degree, all have been shown to be effective in relieving mild to moderate GERD, compared with placebo. The combination of H2 receptor antagonists/antacid is better at symptom relief than are its constituent components alone.
A review of randomized clinical trials comparing two or more proton pump inhibitors (PPIs) found that there are minimal clinical differences between the products. Omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), and rabeprazole (Aciphex) all produce comparable rates of healing and remission of sores in the esophagus caused by reflux. Time to healing for esomeprazole (Nexium) may be shorter than that of the other PPIs; however, the clinical significance of this is not substantiated.
When reviewing data on the connection between cancer and Barrett's esophagus (BE), a condition preceded by chronic GERD, the panel agreed with a recent report concluding that the cancer risk is significantly lower than previously thought. Publication bias, or selectively reporting studies with positive results, led to the inflated risk estimates. After adjusting for bias, the annual incidence of cancer in patients with BE is more likely closer to 0.5% than the 1% widely accepted in the past. Computer models have suggested that a risk of cancer of more than 1% warrants yearly endoscopic screening.
Endoscopic treatment is not a recommended therapy for GERD at present due to lack of data on the procedure's efficacy.
Surgery to wrap the top of the stomach around the esophagus, called fundoplication, is not an effective way to prevent esophageal cancer.
There is no reason for patients whose heartburn responds to drug therapy to have routine endoscopy.
There is inadequate information to determine whether or not reflux causes pulmonary symptoms.
Steven Peikin, M.D, professor of medicine at the Robert Wood Johnson Medical School, Camden, N.J., and head of gastroenterology at the Cooper Health System, Camden, was pleased with the panel's recommendation for self-treatment of GERD with OTCs.
"There's always been a debate over whether or not patients with heartburn should go to their doctor immediately or whether they can self-treat if symptoms are controlled by OTC medications. The consensus is that it's OK to self-treat for at least four weeks, but if problems continue, a doctor should be consulted."
Peikin was enthusiastic about the panel's advice regarding the effectiveness of a combination H2RA/ antacid. He explained that OTC antacids are effective because they work immediately. They do not, however, have a sustaining effect, and the patient must continue taking them. "The H2 blockers have a sustained effect for four or more hours, but they have to be absorbed by the body. The nice thing about a combination antacid or H2 blocker product is that one gets immediate relief from the antacid and sustained relief from the H2 blocker," he said.
To check out the new GERD recommendations, visit www.gastro.org.
Sandra Levy. OTCs play role in new GERD treatment recommendations.