PMID- 38225792 OWN - NLM STAT- MEDLINE DCOM- 20240219 LR - 20240219 IS - 1365-2982 (Electronic) IS - 1350-1925 (Linking) VI - 36 IP - 3 DP - 2024 Mar TI - Latin American consensus on diagnosis of gastroesophageal reflux disease. PG - e14735 LID - 10.1111/nmo.14735 [doi] AB - BACKGROUND: Diagnosing gastroesophageal reflux disease (GERD) can be challenging given varying symptom presentations, and complex multifactorial pathophysiology. The gold standard for GERD diagnosis is esophageal acid exposure time (AET) measured by pH-metry. A variety of additional diagnostic tools are available. The goal of this consensus was to assess the individual merits of GERD diagnostic tools based on current evidence, and provide consensus recommendations following discussion and voting by experts. METHODS: This consensus was developed by 15 experts from nine countries, based on a systematic search of the literature, using GRADE (grading of recommendations, assessment, development and evaluation) methodology to assess the quality and strength of the evidence, and provide recommendations regarding the diagnostic utility of different GERD diagnosis tools, using AET as the reference standard. KEY RESULTS: A proton pump inhibitor (PPI) trial is appropriate for patients with heartburn and no alarm symptoms, but nor for patients with regurgitation, chest pain, or extraesophageal presentations. Severe erosive esophagitis and abnormal reflux monitoring off PPI are clearly indicative of GERD. Esophagram, esophageal biopsies, laryngoscopy, and pharyngeal pH monitoring are not recommended to diagnose GERD. Patients with PPI-refractory symptoms and normal endoscopy require reflux monitoring by pH or pH-impedance to confirm or exclude GERD, and identify treatment failure mechanisms. GERD confounders need to be considered in some patients, pH-impedance can identify supragrastric belching, impedance-manometry can diagnose rumination. CONCLUSIONS: Erosive esophagitis on endoscopy and abnormal pH or pH-impedance monitoring are the most appropriate methods to establish a diagnosis of GERD. Other tools may add useful complementary information. CI - (c) 2024 John Wiley & Sons Ltd. FAU - Olmos, Jorge A AU - Olmos JA AD - Neurogastroenterology Sector, Hospital de Clinicas Jose de San Martin, Universidad de Buenos Aires, Buenos Aires, Argentina. FAU - Pandolfino, John E AU - Pandolfino JE AD - Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. FAU - Piskorz, Maria M AU - Piskorz MM AD - Neurogastroenterology Sector, Hospital de Clinicas Jose de San Martin, Universidad de Buenos Aires, Buenos Aires, Argentina. FAU - Zamora, Natalia AU - Zamora N AD - Hospital San Jose de Pergamino, Buenos Aires, Argentina. FAU - Valdovinos Diaz, Miguel A AU - Valdovinos Diaz MA AD - UNAM, Ciudad de Mexico, Mexico. AD - Department of Gastroenterology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico. FAU - Remes Troche, Jose M AU - Remes Troche JM AUID- ORCID: 0000-0001-8478-9659 AD - Institute of Medical Biological Research, Universidad Veracruzana, Veracruz, Mexico. FAU - Guzman, Mauricio AU - Guzman M AD - Neurogastroenterology Unit, Gastroenterology Service, Hospital San Martin de La Plata, Buenos Aires, Argentina. FAU - Hani, Albis AU - Hani A AD - Hospital San Ignacio-Pontificia Universidad Javeriana, Bogota, Colombia. FAU - Valdovinos Garcia, Luis R AU - Valdovinos Garcia LR AD - Gastrointestinal Motility Laboratory, Fundacion Clinica Medica Sur, Mexico City, Mexico. FAU - Pitanga Lukashok, Hannah AU - Pitanga Lukashok H AD - Digestive Motility Service, Instituto Ecuatoriano de Enfermedades Digestivas-IECED, Guayaquil, Ecuador. FAU - Domingues, Gerson AU - Domingues G AD - State University of Rio de Janeiro, Rio de Janeiro, Brazil. FAU - Vesco, Eduardo AU - Vesco E AD - Neuromotility Unit, Clinica Angloamericana, Lima, Peru. AD - Universidad Nacional Mayor de San Marcos, Lima, Peru. FAU - Rivas, Mariel Mejia AU - Rivas MM AD - Internal Medicine, Gastroenterology and Digestive Endoscopy Service, Hospital Vivian Pellas, Managua, Nicaragua. FAU - Ovalle, Luis F Pineda AU - Ovalle LFP AD - Neurogastroenterology and Motility Service Motility Instituto Gut Medica, Bogota, Colombia. FAU - Cisternas, Daniel AU - Cisternas D AD - Clinica Alemana de Santiago, School of Medicine, Universidad del Desarrollo, Clinica Alemana, Vitacura, Chile. FAU - Vela, Marcelo F AU - Vela MF AUID- ORCID: 0000-0002-5350-4654 AD - Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA. LA - eng GR - R01 DK092217/DK/NIDDK NIH HHS/United States PT - Journal Article DEP - 20240115 PL - England TA - Neurogastroenterol Motil JT - Neurogastroenterology and motility JID - 9432572 RN - 0 (Proton Pump Inhibitors) SB - IM MH - Humans MH - Consensus MH - Latin America MH - Esophageal pH Monitoring MH - *Gastroesophageal Reflux/diagnosis/therapy MH - *Esophagitis MH - Proton Pump Inhibitors OTO - NOTNLM OT - ambulatory reflux monitoring OT - gastroesophageal reflux disease EDAT- 2024/01/16 06:42 MHDA- 2024/02/19 06:42 CRDT- 2024/01/16 01:02 PHST- 2023/12/05 00:00 [revised] PHST- 2022/12/26 00:00 [received] PHST- 2023/12/18 00:00 [accepted] PHST- 2024/02/19 06:42 [medline] PHST- 2024/01/16 06:42 [pubmed] PHST- 2024/01/16 01:02 [entrez] AID - 10.1111/nmo.14735 [doi] PST - ppublish SO - Neurogastroenterol Motil. 2024 Mar;36(3):e14735. doi: 10.1111/nmo.14735. Epub 2024 Jan 15.