What are the Gastroenterological Society of Australia (GESA) guidelines on gastroesophageal reflux disease (GORD)?

From the Guidelines

The Gastroenterological Society of Australia (GESA) guidelines for gastroesophageal reflux disease (GORD) recommend a personalized approach to management, with a focus on lifestyle modifications and proton pump inhibitors (PPIs) as first-line therapy, as suggested by the most recent study 1.

Key Recommendations

• Initial treatment involves lifestyle modifications including weight loss, avoiding late meals, elevating the head of the bed, and avoiding trigger foods, as these changes can help reduce acid reflux episodes and esophageal exposure to stomach acid 1.
• For medication, PPIs are the first-line therapy, starting with standard doses such as omeprazole 20mg, esomeprazole 40mg, or pantoprazole 40mg once daily, taken 30 minutes before breakfast for 4-8 weeks, as recommended by the AGA clinical practice update 1.
• If symptoms persist, doubling the PPI dose or switching to another PPI may be considered, and for maintenance therapy, the lowest effective dose should be used, to minimize potential risks and benefits 1.
• H2-receptor antagonists like ranitidine 150mg twice daily can be used for less severe symptoms or as add-on therapy, and antacids and alginates provide rapid but short-term relief and can be used as needed, as suggested by previous studies 1.

Personalized Approach

• Clinicians should develop a care plan for investigation of symptoms suggestive of GERD, selection of therapy, and long-term management, including possible de-escalation, in a shared-decision making model with the patient, as recommended by the AGA clinical practice update 1.
• Patients with persistent extra-oesophageal symptoms despite PPI therapy should be investigated for non-GORD aetiologies prior to endoscopy or ambulatory pH testing, as suggested by the Asia-Pacific consensus on the management of GORD 1.
• Weight reduction in those who are overweight or obese can improve symptom control, although data on the long-term effect are limited, as noted in the Asia-Pacific consensus on the management of GORD 1.

From the Research

GESA Guidelines on GORD

The provided studies do not explicitly mention the GESA guidelines on GORD. However, the studies provide information on the management and treatment of GORD.

Diagnosis and Treatment of GORD

• Diagnosis of GORD is made on the basis of symptoms and the decision to treat is based on the symptom pattern 2.
• Endoscopy is reserved for cases where there are alarm symptoms, diagnostic uncertainty, poor response to treatment or clinical suspicion of a complication such as Barrett's oesophagus or stricture 2.
• A 'step down' approach to treatment involves treating with a PPI for 4-8 weeks, followed by reduction to maintenance doses, intermittent therapy or withdrawal of treatment 2.
• The primary treatment goals in patients with GORD are relief of symptoms, prevention of symptom relapse, healing of erosive esophagitis and prevention of complications 3.

Lifestyle Measures in the Management of GORD

• Lifestyle and dietary factors are commonly cited as risk factors for GORD, and modification of these factors has been advocated as first-line measures for the management of GORD 4.
• Weight reduction and smoking cessation are beneficial in reducing GORD symptoms 4.
• Physical measures, modification of meal size and timing, and avoidance of certain dietary ingredients may also be beneficial in managing GORD 4.

Proton Pump Inhibitors in the Management of GORD

• Proton pump inhibitors (PPIs) are the most effective therapy for symptom relief, healing and long-term maintenance of GORD 3, 5.
• PPIs are more effective for acid-related symptoms and higher endoscopic healing rates in comparison with H2-RAs 3.
• However, long-term use of PPIs has raised concerns about adverse events and overprescribing 6.