Developed and approved by the American College of Gastroenterology, these guidelines summarize advances in gastroesophageal reflux disease (GERD) diagnostic testing and how they have modified the clinical management of esophageal disorders.
"Gastroenterologists are confronted with an increasing number of patients presenting symptoms of GERD that are unresponsive to drug therapy," says lead author Dr. Ikuo Hirano. "These patients may have typical reflux symptoms of heartburn and regurgitation but also may complain of chest pain, asthma, chronic cough and chronic laryngitis." This confusing list of symptoms, coupled with the fact that many of these patients do not have visible esophageal erosions, makes diagnosis and treatment of GERD a challenge. Furthermore, non-gastrointestinal entities, such as cardiac or pulmonary disease, may produce symptoms that are similar to those attributable to GERD.
Some new technologies offer opportunities for more accurate diagnoses. "Wireless capsule pH monitoring, bile acid reflux monitoring devices and esophageal impedance can all improve the detection of reflux," says Dr. Hirano. These technologies have helped gastroenterologists to discover new forms of reflux, and to better characterize traditional acid reflux.
Of course, all technologies have limitations, and the new guidelines highlight these as well. In addition, recommendations on the clinical applications of esophageal reflux testing are presented.