Gastroesophageal reflux disease. Standards of the Czech society of gastroenterology – actualization 2009

Czech version

Authors: K. Lukáš ¹; J. Bureš ²; V. Drahoňovský ³; A. Hep ⁴; V. Jirásek ¹; V. Mandys ⁵; J. Martínek ⁶; P. Richter ⁷; A. Štrosová ⁶
Authors‘ workplace: IV. interní klinika 1. lékařské fakulty UK a VFN Praha, přednosta prof. MUDr. Aleš Žák, DrSc. ¹; Gastroenterologické pracoviště II. interní kliniky Lékařské fakulty UK a FN Hradec Králové, přednosta prof. MUDr. Jaroslav Malý, CSc. ²; Interní oddělení nemocnice Neratovice, přednosta prim. MUDr. Václav Drahoňovský ³; Endoskopické centrum FN Brno, pracoviště Bohunice, vedoucí prof. MUDr. Aleš Hep, CSc., a Klinika interní, geriatrie a praktického lékařství Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednostka prof. MUDr. Hana Matějovská Kubešová, CSc. ⁴; Ústav patologie 3. lékařské fakulty UK a FN Královské Vinohrady Praha, přednosta prof. MUDr., Václav Mandys, CSc. Recenzovali: prof. MUDr. Petr Dítě, DrSc., Interní hepatogastroenterologická klinika Lékařské fakulty MU Brno, pracoviště Bohunice, a doc. MU ⁵; Interní klinika 1. lékařské fakulty UK a ÚVN Praha, přednosta prof. MUDr. Milan Zavoral, Ph. D. ⁶
Published in: Vnitř Lék 2009; 55(10): 967-975
Category: Guidelines

Overview

Presently, gastroesophageal reflux disease is defined as a disorder where reflux of the stomach content is bothersome and/ or brings about complications. The state when macroscopically detectable erosions of mucosa are present is known as erosive reflux disease and the term non‑erosive reflux disease is used for the condition with no macroscopic erosions. Reflux oesophagitis is a frequent sign of the disease. A condition, where reflux symptoms persist or new occur and oesophagitis healing fails to take place despite maximum treatment, is classified as refractory gastroesophageal reflux disease. The main symptoms of gastroesophageal reflux disease include heartburn and regurgitation. Gastroesophageal reflux disease may, less frequently, manifest itself with isolated non‑oesophageal symptoms, e. g. recurring upper respiratory tract infections or bronchial asthma. Etiopathogenesis involves refluxate, motility disorders, altered anatomic proportions, protective mechanisms disorder and external factors. Diagnosis takes place on the basis of typical symptomatology and endoscopic examination. Complications include bleeding, ulceration, strictures and Barrett’s oesophagus. Lifestyle and dietary measures are an important treatment approach as are pharmacological (antisecretion and prokinetic agents) as well as surgical management.

Key words:
gastroesophageal reflux disease – refractory gastroesophageal reflux disease – reflux oesofagitis – hiatus hernia – Barrett’s oesophagus – proton pump inhibitors – prokinetic agents

Sources

1. Armstrong D. Systematic review: persistence and Severiny in gastro‑oesophageal reflex disease. Aliment Pharmacol Ther 2008; 28: 841– 853.

2. Barlow WJ, Orlando RC. The pathogenesis of heartburn in nonerosive reflux disease: a unifying hypothesis. Gastroenterology 2005; 128: 771– 778.

3. Boeckxstaens GE. Review article: The pathophysiology of gastro‑oesophageal reflux disease. Aliment Pharmacol Ther 2007; 26: 149– 160.

4. Cameron AJ, Carpenter HA. Barrett’s esophagus, high grade dysplasia and early adenocarcinoma. Comparison of endoscopic biopsy and surgical pathology finding. Gut 1996; 38 (Suppl 1): T92.

5. Coron E, Hatlebakk JG, Galmiche JP. Medical therapy of gastroesophageal reflux disease. Curr Opin Gastroenterol 2007; 23: 434– 439.

6. De Meester TR, Peters JH, Bremner CG et al. Biology of gastro‑esophageal reflux disease. Ann Rev Med 1999; 50: 469– 506.

7. Dent J, Brun J, Fendrick AM et al. An evidence‑based appraisal of reflux disease management – the Genval Workshop Report. Gut 1999; 44 (Suppl 2): S1– S13.

8. DeVault KR. Review article: the role of acid suppression in patients with non‑erosive reflux disease or functional heartburn. Aliment Pharmacol Ther 2006; 23 (Suppl 1): 33– 39.

9. Drahoňovský V, Vrbenský L, Hnuta J et al. Pozitivní vliv laparoskopické antirefluxní operace na vývoj slizničních změn Barrettova jícnu pět a více let od provedené operace. Čes Slov Gastroenterol Hepatol 2008; 62: 190– 202.

10. Drossmann DA. The Functional Gastrointestinal Disorders and the Rome III Process. Gastroenterology 2006; 130: 1377– 1390.

11. Duda M, Hildebrand T Refluxní nemoc jícnu. In: Mařatka Z (ed). Gastroenterologie. Praha: Karolinum 1999: 79– 88.

12. Egan LJ, Myhre GM, Mays DC et al. CYP2C19 pharmacogenetics in the clinical use of proton- pump inhibitors for gastro‑oesophageal reflux disease: variant alleles predict gastric acid suppression, but no oesophageal acid exposure or reflux symptoms. Aliment Pharmacol Ther 2003; 17: 1521– 1528.

13. Fass R, Gasiorowska A. Refractory GERD: what is it? Curr Gastroenterol Rep 2008; 10: 252– 257.

14. Fass R, Sifrim D. Management of heartburn not responding to proton pump inhibitors. Gut 2009; 58: 295– 309.

15. Fennerty MB, Castell DO, Fendrick AM et al. The diagnosis and treatment of gastroesophageal reflux disease in a managed care environment. Arch Intern Med 1996; 156: 477– 484.

16. Fornari F, Sifrim D. Diagnostic options for patients with refractory GERD. Curr Gastroenterol Rep 2008; 10: 283– 288.

17. Geagea A, Cellier C. Scope of drug‑induced, infectious and allergic esophageal injury. Curr Opin Gastroenterol 2008; 24: 496– 501.

18. Goyal RK. Diseases of the Esophagus. In: Fauci AS, Braunwald E, Kasper DL et al (eds). Harrison’s Principles of Internal Medicine. New York: McGrawHill 2008: 1847– 1855.

19. Ismail- Beigi F, Horton PF, Pope CE 2nd. Histological consequences of gastroesophageal reflux in man. Gastroenterology 1970; 58: 163– 174.

20. Jirásek V, Procházka V, Dostalík Z et al. Helicid (omeprazol) v léčbě refluxní ezofagitidy. Cesk Slov Gastroenterol Hepatol 2000; 54: 43– 46.

21. Kahrillas PJ. GERD revisited: advances in pathogenesis. Hepatogastroenterology 1998; 45: 1301– 1307.

22. Kahrilas PJ. Clinical practice. Gastroesophageal reflux disease. N Engl J Med 2008; 359: 1700– 1707.

23. Katz PO. Medical therapy for gastroesophageal reflux disease in 2007. Rev Gastroenterol Disord 2007; 7: 193– 203.

24. Kim YS, Kim TH, Choi CS et al. Effect of itopride, a new prokinetic, in patients with mild GERD: a pilot study. World J Gastroenterol 2005; 11: 4210– 4214.

25. Lukáš K a spol. Refluxní choroba. Diagnostika a léčba pro praxi. Praha, Univerzita Karlova: Nakladatelství Karolinum 2003.

26. Martínek J, Beneš M, Brandtl P et al. Low incidence of adenocarcinoma and high‑grade intraepithelial neoplasia in patients with Barrett’s esophagus: a prospective cohort study. Endoscopy 2008; 40: 711– 716.

27. Martínek J, Beneš M, Hucl T et al. Non- erosive and erosive gastroesophageal reflux disease: No difference with regard to reflux pattern and motility abnormalities. Scand J Gastroenterol 2008; 43: 794– 800.

28. Miyamoto M, Haruma K, Kuwabara Met al. Long‑term gastroesophageal reflux disease therapy improves reflux symptoms in elderly patients: Five‑year prospective study in community medicine. J Gastroenterol Hepatol 2007; 22: 639– 644.

29. Miyamoto M, Haruma K, Takeuchi K et al. Frequency scale for symptoms of gastroesophageal reflux disease predicts the need for addition of prokinetics to proton pump inhibitor therapy. J Gastroenterol Hepatol 2008; 23: 746– 751.

30. Monaco L, Brillantino A, Torelli F et al. Prevalence of bile reflux in gastroesophageal reflux disease patients not responsive to proton pump inhibitors. World J Gastroenterol 2009; 15: 334– 338.

31. Ogorek CP. Gastroesophageal Reflux Disease. In: Haubrich SW, Schaffner F, Berk JE (eds). Bockus Gastroenterology. Philadelphia: W.B.Saunders 1995: 445– 452.

32. Piche T, Galmiche JP. Pharmacological targets in gastro‑oesophageal reflux disease. Basic Clin Pharmacol Toxicol 2005; 97: 333– 341.

33. Pohle T, Domschke W. Results of short- and long‑term medical treatment of gastroesophageal reflux disease. Langenbecks Arch Surg 2000; 385: 317– 323.

34. Richter JE. Gastroesophageal Reflux Disease and Its Complications. In: Feldman M,Friedman FS, Brandt LJ (eds). Gastrointestinal and Liver Disease. Philadelphia: Saunders Elservier 2006: 905– 936.

35. Richter JE. Gastroesophageal Reflux Disease. In: Yamada T (ed). Textbook of Gastroenterology. Oxford, Chichester, Hoboken: Willey-Blackwell 2009: 772–801.

36. Richter JE. The patient with refractory gastroesophageal reflux disease. Dis Esophagus 2006; 19: 443– 447.

37. Richter JE. How to manage refractory GERD. Nat Clin Pract Gastroenterol Hepatol 2007; 4: 658– 664.

38. Scarpignato C, Pelosini I. Review article: the opportunities and benefits of extended acid suppression. Aliment Pharmacol Ther 2006; 23 (Suppl 2): 23– 34.

39. Sgouros SN, Mantides A. Refractory heartburn to proton pump inhibitors: epidemiology, etiology and management. Digestion 2006; 73: 218– 226.

40. Sharma P, Armstrong D, Bergman JJet al. The development and validation of an endoscopic grading system for Barrett’s esophagus – the Prague C and M criteria. Gastroenterology 2006; 57: 1392– 1399.

41. Sharma P, Wani S, Romero Y et al. Racial and geographic issues in gastroesophageal reflux disease. Am J Gastroenterol 2008; 103: 2669– 2680.

42. Smout AJ. Advances in esophageal motor disorders. Curr Opin Gastroenterol 2008; 24: 485– 489.

43. Spechler SJ, Lee E, Ahnen D et al. Long‑term outcome of medical and surgical therapies for gastroesophageal reflux disease: follow‑up of a randomized controlled trial. JAMA 2001; 285: 2331– 2338.

44. Tutuian R, Vela MF, Hill EG et al. Characteristics of symptomatic reflux episodes on acid suppressive therapy. Am J Gastroenterol 2008; 103: 1090– 1096.

45. Tytgat GN. Esophagology 2008: any progress? Curr Opin Gastroenterol 2008; 57: 482– 484.

46. van Malenstein H, Farré R, Sifrim D. Esophageal dilated intercellularspaces (DIS) and nonerosive reflux disease. Am J Gastroenterol 2008; 103: 1021– 1028.

47. 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: 1900– 1920.