EAES recommendations for the management of gastroesophageal reflux disease.
BACKGROUND
Gastroesophageal reflux disease (GERD) is one of the most frequent benign disorders of the upper gastrointestinal tract. Management of GERD has always been controversial since modern medical therapy is very effective, but laparoscopic fundoplication is one of the few procedures that were quickly adapted to the minimal access technique. The purpose of this project was to analyze the current knowledge on GERD in regard to its pathophysiology, diagnostic assessment, medical therapy, and surgical therapy, and special circumstances such as GERD in children, Barrett's esophagus, and enteroesophageal and duodenogastroesophageal reflux.


METHODS
The European Association of Endoscopic Surgery (EAES) has tasked a group of experts, based on their clinical and scientific expertise in the field of GERD, to establish current guidelines in a consensus development conference. The expert panel was constituted in May 2012 and met in September 2012 and January 2013, followed by a Delphi process. Critical appraisal of the literature was accomplished. All articles were reviewed and classified according to the hierarchy of level of evidence and summarized in statements and recommendations, which were presented to the scientific community during the EAES yearly conference in a plenary session in Vienna 2013. A second Delphi process followed discussion in the plenary session.


RESULTS
Recommendations for pathophysiologic and epidemiologic considerations, symptom evaluation, diagnostic workup, medical therapy, and surgical therapy are presented. Diagnostic evaluation and adequate selection of patients are the most important features for success of the current management of GERD. Laparoscopic fundoplication is the most important therapeutic technique for the success of surgical therapy of GERD.


CONCLUSIONS
Since the background of GERD is multifactorial, the management of this disease requires a complex approach in diagnostic workup as well as for medical and surgical treatment. Laparoscopic fundoplication in well-selected patients is a successful therapeutic option.
Department of Surgery, AGAPLESION Markus Krankenhaus, Wilhelm-Epstein-Str. 4, 60431, Frankfurt, Germany, karl-hermann.fuchs@fdk.info.
Karl Hermann
KH
Fuchs
Benjamin
B
Babic
Wolfram
W
Breithaupt
Bernard
B
Dallemagne
Abe
A
Fingerhut
Edgar
E
Furnee
Frank
F
Granderath
Peter
P
Horvath
Peter
P
Kardos
Rudolph
R
Pointner
Edoardo
E
Savarino
Maud
M
Van Herwaarden-Lindeboom
Giovanni
G
Zaninotto
D000328:Adult; D000863:Antacids / Q000627:therapeutic use; D001471:Barrett Esophagus / Q000175:diagnosis; D002648:Child; D003937:Diagnosis, Differential; D016145:Endoscopy, Digestive System; D050782:Esophageal pH Monitoring; D005060:Europe; D018662:Fundoplication / Q000379:methods / Q000592:standards*; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000628:therapy*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D010535:Laparoscopy / Q000592:standards*; D008365:Manometry / Q000379:methods; D018579:Patient Selection; D054328:Proton Pump Inhibitors / Q000008:administration & dosage; D012008:Recurrence; D012955:Societies, Medical / Q000592:standards*
D000863:Antacids; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors