GI tract

PPIs remain frontline treatment for GERD: Guidelines

Proton pump inhibitors remain a frontline treatment for gastro-oesophageal reflux disease, new guidelines have confirmed.

The latest update to the Asia-Pacific consensus on the management of GERD – the first since 2008 – has been published in the British Medical Journal’s publication Gut.

Co-author, Professor Gerald Holtmann, Director of Gastroenterology and Hepatology, Princess Alexandra Hospital in Queensland, said a total of 32 statements were proposed by the consensus and 31 were accepted – an impressive outcome Professor Holtmann said.

“We had some very intense discussions,” he revealed.

The authors noted a rise in the prevalence rates of gastro-oesophageal reflux disease in Asia, mostly non-erosive reflux disease. Overweight and obesity contributed to the rise, and PPI -refractory reflux disease was recognised as common.

Professor Holtmann told the limbic that while PPIs were a frontline treatment for patients with GERD, 28-30% of patients did not respond.

This may be a sign the patient has volume reflux as opposed to acid reflux, and these patients may benefit from the use of a prokinetic agent in combination with the PPI.

In some cases surgical intervention might be helpful, however he said this could exacerbate the condition in some patients so needed to be carefully considered.

If none of these treatments prove successful, and diagnostics have failed to shed any light on the cause, Professor Holtmann said the problem could be related to a hypersensitivity issue.

Prescribing a tricyclic antidepressant has proved effective in treating symptoms in these cases, he said.

The consensus had also looked at identifying patients with Barrett’s oesophagus at risk of developing cancer, Professor Holtman said.

Long-term GERD is a primary risk factor in the development of Barrett’s oesophagus, which has been linked to an increased cancer risk.

Professor Holtmann said that while it was still important to monitor patients with Barrett’s oesophagus, the risk was low.

“This now seems to be less than first thought,” he said. “There’s no reason to panic – there is a risk but the risk is low and should not cause Barrett’s phobia.”

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