[Diagnosis and treatment of gastroesophageal reflux in the adult: guidelines recommended by French and Belgian consensus].
Usual gastroesophageal reflux (GER) presentations are heartburn and acid regurgitation. The prevalence in occidental population ranges from 5 to 45% according to symptoms frequency. Oesophagitis is observed in 30 to 50% of examined patients and only erosive and ulcerative lesions must be considered. Distinction is made between non-severe oesophagitis (isolated loss of substance), severe oesophagitis (circonferential loss of substance) and complicated oesophagitis (stenosis, ulcerations, brachyoesophagus). 24-hour pH-monitoring analyses reflux duration and relations between symptoms and reflux specially in unusual extraoesophageal presentations. Symptoms and quality of life are the main criteria for staging. In few patients, oesophagitis is severe. Complications (stenosis, ulcerations, bleeding, endobrachyoesophagus) are observed in 10 to 15% of cases. Endobrachyoesophagus with intestinal metaplasia is a risk for neoplasia. The consensus conference proposes this initial therapeutic strategy. In cases of time-spaced symptoms: antiacids, alginic acid or low doses of anti-H2 with life style changes. In cases of typical frequent symptoms, in patients younger than 50 years: 4-weeks treatment with half dosed proton pump inhibitors (PPI) or standard doses of anti-H2 or prokinetics. Nowadays, the majority of the experts propose empiric full-dose treatment. This attitude is more logical as total symptoms suppression with full dose PPI brings positive clues for exact GOR diagnostic without endoscopy. In patients older than 50 years or with alarming symptoms (weight loss, dysplagia, bleeding, anemia): endoscopy must be performed. Patients with non severe oesophagitis: PPI without checking endoscopy. In patients with severe or complicated oesophagitis: 8-weeks treatment following by endoscopy; in non relieved patients: doses are increased. In cases of extraoesophageal presentations: standard PPI treatment during 4 to 8 weeks if GER is well established. In long term strategy, if recidives are rare: intermittent treatment. In early and frequent recidives: long term adapted PPI or surgery. Stenosis are treated by PPI, pneumatic dilatation or surgery if unsuccessful. Brachyoesophagus must be checked by endoscopy every 2 years (malignancy risk).
Service de Gastro-entérologie, C.H.U. de Charleroi, Site de Charleroi, U.L.B.
J P
JP
Henry
A
A
Lenaerts
G
G
Ligny
D000328:Adult; D000367:Age Factors; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001530:Belgium / Q000453:epidemiology; D004945:Esophagoscopy; D005602:France / Q000453:epidemiology; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D005773:Gastroscopy; D006801:Humans; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011788:Quality of Life; D016896:Treatment Outcome
D000897:Anti-Ulcer Agents