Abbreviated as GERD, Gastroesophageal reflux disease is a common illness encountered by majority of gastroenterologists. Furthermore, primary care providers find a significant number of GERD complaints in their practice. This presentation is based on the Gastroesophageal reflux disease's clinical practice, including its background, prevalence, clinical presentation, pathophysiology, applicability in primary care, and recommendations for patients with the same condition.
Disease and Background
At its core, the definition of GERD is not precise but determined by numerous symptoms and impacts on end organs and complications of the esophagus, lung, and the oral cavity. According to the American Journal of Gastroenterology, GERD's prevalence is between 10 and 20 % among Western populations and lower in Asia (Kertz, Gerson & Vela, 2013). The disease's prevalence is primarily dependent on the clinical presentations of the disease, which range from esophageal heartburn and regurgitation. Furthermore, approximately 6% of the population diagnosed with GERD presents heartburn complaints. The extent of severity is associated with esophageal and gastric refluxate. Besides, the pathophysiology is multifactorial, with determining factors such as reflux exposure, visceral sensitivity, and epithelial resistance.
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Publication and Application in Primary Care
In this article, the clinical practice guidelines were developed by Gastroenterology experts who include Kertz, Gerson, and Vela. The American Journal of Gastroenterology published the guidelines. The publication was initially done in 2013. Since their publication, these guidelines have helped manage and treat patients presenting the disease. Their application in the primary care setting is crucial because different patients present various GERD symptoms. Furthermore, some patients present non-erosive reflux, which is quite different from the rest. Besides, multiple symptoms of GERD require different treatments as outlined in the CPG. The fact that GERD is a common complaint among primary care providers, the primary care guideline is crucial for its treatment.
Key Statements and Body of Evidence
The guidelines for GERD have key actions and recommendations made from the point of diagnosis to management. The first essential action is to avoid the use of Barium radiographs while diagnosing for the disease. There is strong evidence suggesting that unless combined with dysphagia, the sensitivity of the Barium radiograph test is low. Barium reflux with water siphon maneuvers increases visceral sensitivity. The second essential action is lifestyle changes as therapeutical treatment for GERD. One highly recommended lifestyle intervention is weight loss. This is especially for patients who are overweight or have recently added significant weight. The level of evidence for this recommendation is moderate and applies only to patients that are overweight.
In GERD management, a key recommendation is the use of PPIs for eight consecutive weeks for relieving the symptoms and healing the erosive esophagus. The proposal has a high level of evidence as there is no significant difference in efficacy between the different PPIs. Besides, evidence reveals partial relief of GERD symptoms for patients taking PPIs once or twice daily (Kertz, Gerson & Vela, 2013). A key action from the Clinical Practice Guidelines is surgical therapy in the long-term management of GERD patients. According to a Cochrane review, of the 1200 patients subjected to surgical treatment, there were significant improvements compared to medical surgery (Kertz, Gerson & Vela, 2013). Surgical therapy is an option for patients who may desire to stop medication, are experiencing difficulties in compliance with medicine or have adverse side effects as a result of the medication.
The fifth and last recommendation is that patients with chronic GERD should consider surgical therapy. The proposal has a high level of evidence. Some of the reasons why GERD patients may prefer surgical treatment include the desire to stop the medication, side-effects associated with the disease, and non-compliance to medical therapy (Kertz, Gerson & Vela, 2013).
Patient Case and Comparison
Recently a patient came to the facility with heartburn complaints. To diagnose GERD, the doctor inserted an endoscope down the throat to inspect the stomach and esophagus. The patient's diagnosis compares with the clinical practice guidelines outlined in the article as the endoscope has been the primary tool used in the diagnosis and evaluation of symptoms such as erosive esophagitis, which are causes of GERD (Kertz, Gerson & Vela, 2013). The patient was found to have acid reflux and was given strong H-2 receptor blockers. The patient's treatment is similar to that indicated on the clinical Guidelines practice based on the rationale that antacids and Histamine-receptor antagonists are for patients whose lifestyles need to be altered to suppress GERD symptoms.
Reference
Katz, P. O., Gerson, L. B., & Vela, M. F. (2013). Guidelines for the diagnosis and management of gastroesophageal reflux disease. Official Journal of the American College of Gastroenterology| ACG , 108 (3), 308-328. https://journals.lww.com/ajg/fulltext/2013/03000/guidelines_for_the_diagnosis_and_management_of.6.aspx
