Reflux

+How to treat
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Reflux

By Cameron Schauer and Jason Robertson
HTT Reflux
[Image: Fraser Williamson]

Cameron Schauer and Jason Robertson describe the symptoms, aetiology, subtypes and consequences of reflux. They also discuss the investigations used for diagnosis, investigating those with alarm features and evaluating success of treatment. Finally, they examine multimodal treatment, including lifestyle, pharmacological and surgical interventions. This article offers bite-sized chunks of information to provide you with all you need to know about this condition

This How to Treat has been endorsed by the RNZCGP and has been approved for up to 2 credits for continuing professional development purposes (2 credit, Educate small, BACK panel - grey
References

1. Vakil N, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: A global evidence-based consensus. Am J Gastroenterol 2006;101(8):1900–20.

2. El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2014;63(6):871–80.

3. Yamasaki T, Hemond C, Eisa M, et al. The changing epidemiology of gastroesophageal reflux disease: Are patients getting younger? J Neurogastroenterol Motil 2018;24(4):559.

4. Wyeth JW. Functional gastrointestinal disorders in New Zealand. J Gastroenterol Hepatol 2011;26(s3):15–18.

5. Dean BB, Aguilar D, Johnson LF, et al. The relationship between the prevalence of nighttime gastroesophageal reflux disease and disease severity. Dig Dis Sci 2010;55(4):952–59.

6. Wu JC. Gastroesophageal reflux disease: An Asian perspective. J Gastroenterol Hepatol 2008;23(12):1785–93.

7. Lee SW. Heartburn and regurgitation have different impacts on life quality of patients with gastroesophageal reflux disease. World J Gastroenterol 2014;20(34):12277.

8. Havemann BD, Henderson CA, El-Serag HB. The association between gastro-oesophageal reflux disease and asthma: a systematic review. Gut 2007;56(12):1654–64.

9. Couillard S, Jackson DJ, Wechsler ME, Pavord ID. Workup of severe asthma. Chest 2021;160(6):2019–29.

10. Eusebi LH, Ratnakumaran R, Yuan Y, et al. Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis. Gut 2018;67(3):430–40.

11. Guadagnoli L, Yadlapati R, Taft T, et al. Esophageal hypervigilance is prevalent across gastroesophageal reflux disease presentations. Neurogastroenterol Motil 2021;33(8):e14081.

12. Böhmer AC, Schumacher J. Insights into the genetics of gastroesophageal reflux disease (GERD) and GERD-related disorders. Neurogastroenterol Motil 2017;29(2):10.1111/nmo.13017.

13. Scida S, Russo M, Miraglia C, et al. Relationship between Helicobacter pylori infection and GERD. Acta Biomed 2018;89(8-S):40–43.

14. Wiklund AK, Santoni G, Yan J, et al. Risk of esophageal adenocarcinoma after Helicobacter pylori eradication treatment in a population-based multinational cohort study. Gastroenterology 2024;167(3):485–92.e3.

15. Dent J. Microscopic esophageal mucosal injury in nonerosive reflux disease. Clin Gastroenterol Hepatol 2007;5(1):4–16.

16. Mainie I, Tutuian R, Shay S, et al. Acid and non-acid reflux in patients with persistent symptoms despite acid suppressive therapy: a multicentre study using combined ambulatory impedance-pH monitoring. Gut 2006;55(10):1398–402.

17. Lei WY, Yu HC, Wen SH, et al. Predictive factors of silent reflux in subjects with erosive esophagitis. Dig Liver Dis 2015;47(1):24–29.

18. Malfertheiner P, Nocon M, Vieth M, et al. Evolution of gastro-oesophageal reflux disease over 5 years under routine medical care–the ProGERD study. Aliment Pharmacol Ther 2012;35(1):154–64.

19. Pregun I, Hritz I, Tulassay Z, Herszényi L. Peptic esophageal stricture: Medical treatment. Digestive Diseases 2009;27(1):31–37.

20. Hayeck TJ, Kong CY, Spechler SJ, et al. The prevalence of Barrett’s esophagus in the US: estimates from a simulation model confirmed by SEER data. Dis Esophagus 2010;23(6):451–57.

21. Shaheen NJ, Richter JE. Barrett’s oesophagus. Lancet 2009;373(9666):850–61.

22. Chandar AK, Low EE, Singer ME, et al. Estimated burden of screening for Barrett’s esophagus in the United States. Gastroenterology 2023;165(1):283–85.e2.

23. Dong J, Grant C, Vuong B, et al. Feasibility and safety of tethered capsule endomicroscopy in patients with Barrett’s esophagus in a multi-center study. Clin Gastroenterol Hepatol 2022;20(4):756–65.e3

24. Pohl H, Welch HG. The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst 2005;97(2):142–46.

25. Ministry of Health. Cancer: Historical summary 1948–2017.

26. Stavrou EP, McElroy HJ, Baker DF, et al. Adenocarcinoma of the oesophagus: incidence and survival rates in New South Wales, 1972-2005. Med J Aust 2009;191(6):310–14.

27. Visrodia K, Singh S, Krishnamoorthi R, et al. Magnitude of missed esophageal adenocarcinoma after Barrett’s esophagus diagnosis: A systematic review and meta-analysis. Gastroenterology 2016;150(3):599–607.e7.

28. Enzinger PC, Mayer RJ. Esophageal cancer. N Engl J Med 2003;349(23):2241–52.

29. Schauer C, Sekra A, Ogra R. Quality of life after oesophageal stenting in patients with palliative oesophageal cancer. N Z Med J 2021;134(1545):106–19.

30. Soeberg M, Blakely T, Sarfati D. Trends in ethnic and socioeconomic inequalities in cancer survival, New Zealand, 1991-2004. Cancer Epidemiol 2015;39(6):860–62.

31. Numans ME, Lau J, de Wit NJ, Bonis PA. Short-term treatment with proton-pump inhibitors as a test for gastroesophageal reflux disease: a meta-analysis of diagnostic test characteristics. Ann Intern Med 2004;140(7):518–27.

32. Ness-Jensen E, Hveem K, El-Serag H, Lagergren J. Lifestyle intervention in gastroesophageal reflux disease. Clin Gastroenterol Hepatol 2016;14(2):175–82.e1–3.

33. Khan M, Santana J, Donnellan C, et al. Medical treatments in the short term management of reflux oesophagitis. Cochrane Database Syst Rev 2007;(2):CD003244.

34. Statista. Leading chemical substances dispensed in England in 2023, by number of items.

35. Forgacs I, Loganayagam A. Overprescribing proton pump inhibitors. BMJ 2008;336(7634):2–3.

36. Graham DY, Tansel A. Interchangeable use of proton pump inhibitors based on relative potency. Clin Gastroenterol Hepatol 2018;16(6):800–08.e7.

37. Clinical Pharmacogenetics Implementation Consortium. CPIC Guideline for Proton Pump Inhibitors and CYP2C19.

38. Tan CM, Juurlink DN. Navigating drug interactions with proton pump inhibitors. JAMA Netw Open 2024;7(7):e2419818.

39. Moayyedi P, Eikelboom JW, Bosch J, et al. Safety of proton pump inhibitors based on a large, multi-year, randomized trial of patients receiving rivaroxaban or aspirin. Gastroenterology 2019;157(3):682–91.e2.

40. Ren LH, Chen WX, Qian LJ, et al. Addition of prokinetics to PPI therapy in gastroesophageal reflux disease: a meta-analysis. World J Gastroenterol 2014;20(9):2412–19.

41. Dickman R, Schiff E, Holland A, et al. Clinical trial: acupuncture vs. doubling the proton pump inhibitor dose in refractory heartburn. Aliment Pharmacol Ther 2007;26(10):1333–44.

42. Wong HJ, Su B, Attaar M, et al. Anti-reflux mucosectomy (ARMS) results in improved recovery and similar reflux quality of life outcomes compared to laparoscopic Nissen fundoplication. Surg Endosc 2021;35(12):7174–82.

43. Kohn GP, Price RR, DeMeester SR, et al. Guidelines for the management of hiatal hernia. Surg Endosc 2013;27(12):4409–28.

44. Salvador R, Vittori A, Capovilla G, et al. Antireflux surgery’s lifespan: 20 years after laparoscopic fundoplication. J Gastrointest Surg 2023;27(11):2325–35.

45. Zhou T, Harnsberger C, Broderick R, et al. Erratum to: Reoperation rates after laparoscopic fundoplication. Surg Endosc 2015;29(3):515–15.

46. Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 2022;117(1):27–56.