Italian guidelines for the diagnosis and management of gastro-esophageal reflux disease: Joint consensus from the Italian Societies of: Gastroenterology and Endoscopy (SIGE), Neurogastroenterology and Motility (SINGEM), Hospital Gastroenterologists and Endoscopists (AIGO), Digestive Endoscopy (SIED), and General Medicine (SIMG)
Abstract
Gastroesophageal reflux disease (GERD) is one of the most common conditions encountered in outpatient general medicine and gastroenterology clinics. However, uncertainties remain, particularly concerning the optimal diagnostic work-up and the most effective management. To address this issue, experts from 5 Italian Societies conducted a Delphi consensus process, which included a review of the current literature and voting process on 27 key statements. Recommendations and quality of evidence were evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. Consensus for each statement was defined as ≥ 80 % agreement. Diagnostic Approach: The consensus supports a symptom-based diagnostic strategy for GERD, focusing on the exclusion of alarm symptoms and/or multiple risk factors for Barrett's esophagus or eosinophilic esophagitis (EoE) as well as non-GERD causes in cases of extra-esophageal symptoms. Esophago-gastro-duodenoscopy (EGD) is recommended in patients with alarm features or in patients unresponsive to proton pump inhibitors (PPIs). In addition, the consensus recommends esophageal pH-metry or impedance-pH recording in patients with reflux-like symptoms not responding to medical treatments, in those with extra-oesophageal symptoms, prior to anti-reflux endoscopic or surgical procedures, in patients with belching disorders and to diagnose functional heartburn (FH) and reflux hypersensitivity (RH) in PPI-refractory patients.…
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