AGA SectionAn Episode Payment Framework for Gastroesophageal Reflux Disease
Section snippets
Symptomatic Gastroesophageal Reflux Disease
Gastroesophageal reflux disease (GERD) is defined by the Montreal consensus as a condition that develops when the reflux of gastric content into the esophagus causes troublesome symptoms or complications.1, 2, 3, 4 This includes the following symptom complexes:
- •
Typical reflux syndrome is defined by the presence of troublesome heartburn and/or regurgitation. Patients can also have other symptoms, such as epigastric pain or sleep disturbance.
- •
Reflux chest pain syndrome is defined as
Nondysplastic Barrett’s Esophagus
There is controversy based on the strength and interpretation of evidence regarding the need for screening and appropriate surveillance interval for nondysplastic BE.5, 6, 7, 8, 9, 10, 11, 12 At present, the published literature does not support performing screening of asymptomatic patients for esophageal cancer at any age. Men or women older than 50 years with chronic GERD symptoms of >5 years duration, nocturnal reflux symptoms, hiatal hernia, elevated body mass index, tobacco use,
Dysplasia in Barrett’s Esophagus
The American Gastroenterological Association episode framework for medical, endoscopic, and surgical evaluation and treatment of dysplasia in BE addresses the following indications:
- •
To obtain a second opinion, preferably from an expert of esophageal pathology, to confirm presence and severity of dysplasia when identified as low-grade (LGD) or high-grade dysplasia (HGD) on biopsies at endoscopy.
- •
After first treatment of active inflammation of the esophagus with 12 weeks of proton pump inhibitor
Anti-Reflux Surgical and Endoscopic Interventions
The American Gastroenterological Association episode framework for endoscopic and surgical treatment of GERD addresses the following indications:
- •
As a maintenance therapy for patients with typical GERD symptoms who respond well to medical therapy and have well-documented GERD.1, 2, 3
- •
As a therapeutic service for patients with typical or atypical symptoms who do not respond to medical therapy. In this case, the diagnosis of GERD must be re-evaluated and confirmed with ambulatory pH/impedence
References (12)
- et al.
Role of endoscopy in the management of GERD
Gastrointest Endosc
(2007) - et al.
American Gastroenterological Association technical review on the management of Barrett's esophagus
Gastroenterology
(2011) - et al.
Validation of the Prague C&M criteria for the endoscopic grading of Barrett’s esophagus by gastroenterology trainees: a multicenter study
Gastrointest Endosc
(2012) - et al.
The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria
Gastroenterology
(2006) - et al.
The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus
Am J Gastroenterol
(2006) - et al.
American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease
Gastroenterology
(2008)
Cited by (1)
How effective is the control of laryngopharyngeal reflux symptoms by fundoplication? Symptom score analysis
2020, European Surgery - Acta Chirurgica Austriaca
Reprint requests Address requests for reprints to: Vice President, Practice & Quality, AGA National Office, 4930 Del Ray Avenue, Bethesda, Maryland 20814. e-mail: [email protected]; telephone: (301) 941-2611.
Conflicts of interest The authors disclose no conflicts.