Gastroesophageal reflux disease and Barrett esophagus: An overview of evidence-based guidelines

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Abstract

Gastroesophageal reflux disease (GERD) is an extremely common condition worldwide, with the published prevalence rates varying from 2.5% in China to 51.2% in Greece. Its economic and morbidity burden is vast, and optimizing care for this condition carries huge financial and patient-related benefits. The disease can be complicated by progression to Barrett esophagus (BE), a precancerous condition that affects approximately 2% of the population and remains undiagnosed in many individuals.

The National Institute of Clinical Excellence has produced guidelines on cost-effective management of GERD in patients in the United Kingdom, and the Benign Barrett’s and Cancer Taskforce consensus was the largest international review of evidence known on the management of benign BE complications. This paper is a review of these guidelines with updates on new evidence. Areas for future development involve risk-stratifying patients to surveillance, chemoprevention agents, and genetic biomarkers to help decide who will be at highest risk of malignant progression. Evidence supports the safety of proton pump inhibitors for symptom control in the medium term (ie, 9 years) and reducing the risk of progression of BE, while surgical options are cost-effective treatments for certain patients. BE surveillance should be directed towards high-risk groups, while those at lower risk may benefit from chemoprevention strategies.