Gastroenterology

Gastroenterology

Volume 150, Issue 4, April 2016, Pages 1019-1025
Gastroenterology

AGA Section
An Episode Payment Framework for Gastroesophageal Reflux Disease

https://doi.org/10.1053/j.gastro.2016.02.037Get rights and content

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)

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Conflicts of interest The authors disclose no conflicts.

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