GuidelineThe American journal of gastroenterology2018
Management options for patients with GERD and persistent symptoms on proton pump inhibitors: recommendations from an expert panel.
Registry-linked trialAbstract readPractice Guideline
In one paragraph
Guideline in The American journal of gastroenterology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05570448 (Anti-Reflux Endoscopic Therapy Using Argon Plasma Coagulation), which is not on this map. Cited by 38 papers, 2 of them syntheses that pooled it.
0numbers the graph read from it
0cells of the map it votes in
38citing papers in PubMed, 2 pooled it
9.3field-weighted citation impact, top 1% of its field
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Anti-Reflux Endoscopic Therapy Using Argon Plasma Coagulation (AREA) in Gastroesophageal Reflux Disease (GERD) Patients: A Single Center, Randomized, Sham, Controlled Trial (The AREA Study)
Who cites it
38 citing papers in PubMed, 2 syntheses or guidelines pooled it, 109 citations in OpenAlex.
- Development of American Society for Gastrointestinal Endoscopy standards for training in advanced endoscopy within dedicated advanced endoscopy fellowship programs.Gastrointestinal endoscopy · 2025Guideline
- ACG Clinical Guidelines: Clinical Use of Esophageal Physiologic Testing.The American journal of gastroenterology · 2020Guideline
- Article
- The pathogenesis and surgical treatment progress of gastroesophageal reflux disease.Frontiers in surgery · 2026Review
- Management of Patients With Refractory Reflux-Like Symptoms Despite Proton Pump Inhibitor Therapy: Evidence-Based Consensus Statements.Alimentary pharmacology & therapeutics · 2025Article
- Hyaluronic acid and chondroitin sulfate-based medical devices: formulations, esophageal mucosal protection, and their place in the management of GERD.Therapeutic advances in gastroenterology · 2025Review
- Anti-Reflux Mucosal Ablation: One More Kid in Town for the Treatment of Gastroesophageal Reflux Disease.GE Portuguese journal of gastroenterology · 2024Article
- Laparoscopic floppy Nissen fundoplication with valve calibration: a safe and efficient procedure.Surgery today · 2024Article
- Current Status of Anti-Reflux Surgery as a Treatment for GERD.Medicina (Kaunas, Lithuania) · 2024Review
- Approach to Management of Refractory Gastroesophageal Reflux Disease.Gastroenterology & hepatology · 2023Article
- The role of magnetic sphincter augmentation in the gastroesophageal reflux disease treatment pathway: the gastroenterology perspective.Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus · 2023Article
- Feasibility and Efficacy of Magnetic Sphincter Augmentation for the Management of Gastroesophageal Reflux Disease Post-Sleeve Gastrectomy for Obesity.Obesity surgery · 2023Observational
- Clinical role of ambulatory reflux monitoring in PPI non-responders: recommendation statements.Alimentary pharmacology & therapeutics · 2022Article
- GERD-related chronic cough: Possible mechanism, diagnosis and treatment.Frontiers in physiology · 2022Review
- Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) for gastroesophageal reflux disease: a systematic review and meta-analysis.Endoscopy international open · 2021Review
- The tapestry of reflux syndromes: translating new insight into clinical practice.The British journal of general practice : the journal of the Royal College of General Practitioners · 2021Article
- Diagnostic yield and reliability of post-prandial high-resolution manometry and impedance-ph for detecting rumination and supragastric belching in PPI non-responders.Neurogastroenterology and motility · 2021Article
- SAGES guidelines for the surgical treatment of gastroesophageal reflux (GERD).Surgical endoscopy · 2021Article
- Magnet-assist endoscopic augmentation of the lower esophageal sphincter for treatment of gastroesophageal reflux disease: cadaveric and survival studies in a porcine model (with video).Surgical endoscopy · 2021Article
- Evaluations of Gastric Acid Pocket Using Novel Vertical 8-Channel pH Monitoring System and Effects of Acid Secretion Inhibitors.Journal of neurogastroenterology and motility · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
17 authors at 8 institutions in 1 country.
Rena YadlapatiAnschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. Weill Cornell Medical Center, New York, NY, USA. Northwestern University, Chicago, IL, USA. Washington University, St. Louis, MO, USA. California Pacific Medical Center, San Francisco, CA, USA. Metro Health Medical Center, Cleveland, OH, USA. Medical University of South Carolina, Charleston, SC, USA. University of Wisconsin, Madison, WI, USA.
Michael F VaeziAnschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. Weill Cornell Medical Center, New York, NY, USA. Northwestern University, Chicago, IL, USA. Washington University, St. Louis, MO, USA. California Pacific Medical Center, San Francisco, CA, USA. Metro Health Medical Center, Cleveland, OH, USA. Medical University of South Carolina, Charleston, SC, USA. University of Wisconsin, Madison, WI, USA.
Marcelo F VelaAnschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. Weill Cornell Medical Center, New York, NY, USA. Northwestern University, Chicago, IL, USA. Washington University, St. Louis, MO, USA. California Pacific Medical Center, San Francisco, CA, USA. Metro Health Medical Center, Cleveland, OH, USA. Medical University of South Carolina, Charleston, SC, USA. University of Wisconsin, Madison, WI, USA.
Stuart J SpechlerAnschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. Weill Cornell Medical Center, New York, NY, USA. Northwestern University, Chicago, IL, USA. Washington University, St. Louis, MO, USA. California Pacific Medical Center, San Francisco, CA, USA. Metro Health Medical Center, Cleveland, OH, USA. Medical University of South Carolina, Charleston, SC, USA. University of Wisconsin, Madison, WI, USA.
Nicholas J ShaheenAnschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. Weill Cornell Medical Center, New York, NY, USA. Northwestern University, Chicago, IL, USA. Washington University, St. Louis, MO, USA. California Pacific Medical Center, San Francisco, CA, USA. Metro Health Medical Center, Cleveland, OH, USA. Medical University of South Carolina, Charleston, SC, USA. University of Wisconsin, Madison, WI, USA.
Joel RichterAnschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. Weill Cornell Medical Center, New York, NY, USA. Northwestern University, Chicago, IL, USA. Washington University, St. Louis, MO, USA. California Pacific Medical Center, San Francisco, CA, USA. Metro Health Medical Center, Cleveland, OH, USA. Medical University of South Carolina, Charleston, SC, USA. University of Wisconsin, Madison, WI, USA.
Brian E LacyAnschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. Weill Cornell Medical Center, New York, NY, USA. Northwestern University, Chicago, IL, USA. Washington University, St. Louis, MO, USA. California Pacific Medical Center, San Francisco, CA, USA. Metro Health Medical Center, Cleveland, OH, USA. Medical University of South Carolina, Charleston, SC, USA. University of Wisconsin, Madison, WI, USA.
David KatzkaAnschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. Weill Cornell Medical Center, New York, NY, USA. Northwestern University, Chicago, IL, USA. Washington University, St. Louis, MO, USA. California Pacific Medical Center, San Francisco, CA, USA. Metro Health Medical Center, Cleveland, OH, USA. Medical University of South Carolina, Charleston, SC, USA. University of Wisconsin, Madison, WI, USA.
Philip O KatzAnschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. Weill Cornell Medical Center, New York, NY, USA. Northwestern University, Chicago, IL, USA. Washington University, St. Louis, MO, USA. California Pacific Medical Center, San Francisco, CA, USA. Metro Health Medical Center, Cleveland, OH, USA. Medical University of South Carolina, Charleston, SC, USA. University of Wisconsin, Madison, WI, USA.
Peter J KahrilasAnschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. Weill Cornell Medical Center, New York, NY, USA. Northwestern University, Chicago, IL, USA. Washington University, St. Louis, MO, USA. California Pacific Medical Center, San Francisco, CA, USA. Metro Health Medical Center, Cleveland, OH, USA. Medical University of South Carolina, Charleston, SC, USA. University of Wisconsin, Madison, WI, USA.
Prakash C GyawaliAnschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. Weill Cornell Medical Center, New York, NY, USA. Northwestern University, Chicago, IL, USA. Washington University, St. Louis, MO, USA. California Pacific Medical Center, San Francisco, CA, USA. Metro Health Medical Center, Cleveland, OH, USA. Medical University of South Carolina, Charleston, SC, USA. University of Wisconsin, Madison, WI, USA.
Lauren GersonAnschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. Weill Cornell Medical Center, New York, NY, USA. Northwestern University, Chicago, IL, USA. Washington University, St. Louis, MO, USA. California Pacific Medical Center, San Francisco, CA, USA. Metro Health Medical Center, Cleveland, OH, USA. Medical University of South Carolina, Charleston, SC, USA. University of Wisconsin, Madison, WI, USA.
Ronnie FassAnschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. Weill Cornell Medical Center, New York, NY, USA. Northwestern University, Chicago, IL, USA. Washington University, St. Louis, MO, USA. California Pacific Medical Center, San Francisco, CA, USA. Metro Health Medical Center, Cleveland, OH, USA. Medical University of South Carolina, Charleston, SC, USA. University of Wisconsin, Madison, WI, USA.
Donald O CastellAnschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. Weill Cornell Medical Center, New York, NY, USA. Northwestern University, Chicago, IL, USA. Washington University, St. Louis, MO, USA. California Pacific Medical Center, San Francisco, CA, USA. Metro Health Medical Center, Cleveland, OH, USA. Medical University of South Carolina, Charleston, SC, USA. University of Wisconsin, Madison, WI, USA.
Jenna CraftAnschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. Weill Cornell Medical Center, New York, NY, USA. Northwestern University, Chicago, IL, USA. Washington University, St. Louis, MO, USA. California Pacific Medical Center, San Francisco, CA, USA. Metro Health Medical Center, Cleveland, OH, USA. Medical University of South Carolina, Charleston, SC, USA. University of Wisconsin, Madison, WI, USA.
Luke HillmanAnschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. Weill Cornell Medical Center, New York, NY, USA. Northwestern University, Chicago, IL, USA. Washington University, St. Louis, MO, USA. California Pacific Medical Center, San Francisco, CA, USA. Metro Health Medical Center, Cleveland, OH, USA. Medical University of South Carolina, Charleston, SC, USA. University of Wisconsin, Madison, WI, USA.
John E PandolfinoAnschutz Medical Campus, University of Colorado, Aurora, CO, USA. Vanderbilt Medical Center, Nashville, TN, USA. Mayo Clinic, Scottsdale, AZ, USA. Baylor Health Care System, Dallas, TX, USA. University of North Carolina, Chapel Hill, NC, USA. University of South Florida, Tampa, FL, USA. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Mayo Clinic, Rochester, MN, USA. Weill Cornell Medical Center, New York, NY, USA. Northwestern University, Chicago, IL, USA. Washington University, St. Louis, MO, USA. California Pacific Medical Center, San Francisco, CA, USA. Metro Health Medical Center, Cleveland, OH, USA. Medical University of South Carolina, Charleston, SC, USA. University of Wisconsin, Madison, WI, USA.
University of Colorado Anschutz Medical Campus · USBaylor Scott & White Health · USMayo Clinic in Arizona · USVanderbilt University Medical Center · USCornell University · USDartmouth–Hitchcock Medical Center · USUniversity of North Carolina at Chapel Hill · USUniversity of South Florida · US
Funding
Targeting Hypervigilance and Autonomic Arousal: the Psycho-physiologic Model of GERDR01DK092217 · NIDDK · NORTHWESTERN UNIVERSITY AT CHICAGO · PI JOHN E PANDOLFINO · 2012 to 2026
$5.0MNIDDK NIH HHS R01 DK092217
Abstract
backgroundThe aim of this study was to assess expert gastroenterologists' opinion on treatment for distinct gastroesophageal reflux disease (GERD) profiles characterized by proton pump inhibitor (PPI) unresponsive symptoms.
methodsFourteen esophagologists applied the RAND/UCLA Appropriateness Method to hypothetical scenarios with previously demonstrated GERD (positive pH-metry or endoscopy) and persistent symptoms despite double-dose PPI therapy undergoing pH-impedance monitoring on therapy. A priori thresholds included: esophageal acid exposure (EAE) time >6.0%; symptom-reflux association: symptom index >50% and symptom association probability >95%; >80 reflux events; large hiatal hernia: >3 cm. Primary outcomes were appropriateness of four invasive procedures (laparoscopic fundoplication, magnetic sphincter augmentation, transoral incisionless fundoplication, radiofrequency energy delivery) and preference for pharmacologic/behavioral therapy.
resultsLaparoscopic fundoplication was deemed appropriate for elevated EAE, and moderately appropriate for positive symptom-reflux association for regurgitation and a large hiatal hernia with normal EAE. Magnetic sphincter augmentation was deemed moderately appropriate for elevated EAE without a large hiatal hernia. Transoral incisionless fundoplication and radiofrequency energy delivery were not judged appropriate in any scenario. Preference for non-invasive options was as follows: H2RA for elevated EAE, transient lower esophageal sphincter relaxation inhibitors for elevated reflux episodes, and neuromodulation/behavioral therapy for positive symptom-reflux association.
conclusionFor treatment of PPI unresponsive symptoms in proven GERD, expert esophagologists recommend invasive therapy only in the presence of abnormal reflux burden, with or without hiatal hernia, or regurgitation with positive symptom-reflux association and a large hiatus hernia. Non-invasive pharmacologic or behavioral therapies are preferred for all other scenarios.
Indexed as
Practice Patterns, Physicians'Behavior TherapyCaliforniaDecision TreesDrug Administration ScheduleEsophagoscopyFemaleFundoplicationGastroesophageal RefluxHumansMaleMiddle AgedProspective StudiesProton Pump InhibitorsProton Pump Inhibitors
Identifiers
What OpenQuestion holds
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Read underepoch 390
Registered trials
NCT05570448ClinicalTrials.gov
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.