New Guidelines Help Identify Patients for Antireflux Surgery

By Reuters Staff

August 20, 2019

NEW YORK (Reuters Health) - New international consensus guidelines offer recommendations for selecting adults with gastroesophageal reflux disorder (GERD) for antireflux surgery.

Dr. Jan Tack from KU Leuven, in Belgium, and a multidisciplinary group supported by the International Society for Diseases of the Esophagus (ISDE) employed a Delphi process to review current evidence and address 37 statements covering clinical presentation and comorbidities and a range of diagnostic modalities when considering patients for antireflux surgery.

According to the ICARUS consensus guidelines, patients with heartburn who respond satisfactorily to proton-pump inhibitors (PPIs), patients with a hiatal hernia, patients with esophagitis of Los Angeles grade B or higher, and patients with Barrett’s esophagus are good candidates for antireflux surgery.

Patients with functional heartburn or eosinophilic esophagitis, on the other hand, are poor candidates for antireflux surgery, the group writes in Gut, online August 2.

All candidates for antireflux surgery should have endoscopy first. Patients suspected of having hiatal hernia or short esophagus should also have a barium swallow, and esophageal manometry is necessary to rule out major motility disorders.

If endoscopy does not show unequivocal reflux esophagitis, esophageal pH monitoring (with or without impedance monitoring) while not taking PPIs should be done before antireflux surgery referral.

Assessment of gastric emptying is unnecessary in patients considered for antireflux surgery, the authors say.

The ICARUS consensus is also endorsed by the European Society for Diseases of the Esophagus, the European Society for Neurogastroenterology and Motility, the American Neurogastroenterology and Motility Society and the European Association for Gastroenterology, Endoscopy and Nutrition.

Dr. Tack did not respond to a request for comments.


Gut 2019.