Multi-society consensus conference and guideline on the treatment of gastroesophageal reflux disease (GERD)


Bethany J. Slater, Advocate Aurora HealthFollow
Amelia Collings, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.Follow
Rebecca Dirks, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Jon C. Gould, Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Alia P. Qureshi, Division of General & GI Surgery, Foregut Surgery, Oregon Health & Science University, Portland, OR, USA.
Ryan Juza, Department of Surgery, University of Wisconsin, Madison, WI, USA.
María Rita Rodríguez-Luna, Research Institute Against Digestive Cancer (IRCAD) and ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France.
Claire Wunker, Saint Louis University, St Louis, MO, USA.
Geoffrey P. Kohn, Department of Surgery, Monash University, Melbourne, VIC, Australia.
Shanu Kothari, Department of Surgery, Prisma Health, Greenville, SC, USA.
Elizabeth Carslon, Virginia Mason Medical Center, Seattle, WA, USA.
Stephanie Worrell, University of Arizona Health Sciences, Tucson, AZ, USA.
Ahmed M. Abou-Setta, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.Follow
Mohammed T. Ansari, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.Follow
Dimitrios I. Athanasiadis, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Shaun Daly, Department of Surgery, University of California, Irvine, Orange, CA, USA.
Francesca Dimou, Washington University in St. Louis, St. Louis, MO, USA.
Ivy N. Haskins, Department of Surgery, University of Nebraska Medical Center, Omaha, USA.
Julie Hong, Department of Surgery, New York Presbyterian/Queens, Queens, USA.
Kumar Krishnan, Massachusetts General Hospital, Boston, MA, USA.
Anne Lidor, Department of Surgery, University of Wisconsin, Madison, WI, USA.
Virginia Litle, Section of Thoracic Surgery, Department of Cardiovascular Surgery, Intermountain Healthcare, Salt Lake City, UT, USA.
Donald Low, Virginia Mason Medical Center, Seattle, WA, USA.
Anthony Petrick, Department of General Surgery, Geisinger School of Medicine, Geisinger Medical Center, Danville, PA, USA.
Ian S. Soriano, Department of Surgery, University of California San Francisco School of Medicine, San Francisco, CA, USA.


Background: Gastroesophageal reflux disease (GERD) is one of the most common diseases in North America and globally. The aim of this guideline is to provide evidence-based recommendations regarding the most utilized and available endoscopic and surgical treatments for GERD.

Methods: Systematic literature reviews were conducted for 4 key questions regarding the surgical and endoscopic treatments for GERD in adults: preoperative evaluation, endoscopic vs surgical or medical treatment, complete vs partial fundoplication, and treatment for obesity (body mass index [BMI] ≥ 35 kg/m2) and concomitant GERD. Evidence-based recommendations were formulated using the GRADE methodology by subject experts. Recommendations for future research were also proposed.

Results: The consensus provided 13 recommendations. Through the development of these evidence-based recommendations, an algorithm was proposed for aid in the treatment of GERD. Patients with typical symptoms should undergo upper endoscopy, manometry, and pH-testing; additional testing may be required for patients with atypical or extra-esophageal symptoms. Patients with normal or abnormal findings on manometry should consider undergoing partial fundoplication. Magnetic sphincter augmentation or fundoplication are appropriate surgical procedures for adults with GERD. For patients who wish to avoid surgery, the Stretta procedure and transoral incisionless fundoplication (TIF 2.0) were found to have better outcomes than proton pump inhibitors alone. Patients with concomitant obesity were recommended to undergo either gastric bypass or fundoplication, although patients with severe comorbid disease or BMI > 50 should undergo Roux-en-Y gastric bypass for the additional benefits that follow weight loss.

Conclusion: Using the recommendations an algorithm was developed by this panel, so that physicians may better counsel their patients with GERD. There are certain patient factors that have been excluded from included studies/trials, and so these recommendations should not replace surgeon-patient decision making. Engaging in the identified research areas may improve future care for GERD patients.



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