Gastro-oesophageal reflux disease in primary care Comparison and evaluation of existing national guidelines and development of uniform European guidelines

Objectives: Symptoms of gastro-oesophageal reflux and gastro(o)esophageal reflux disease (GERD) are common and are managed mainly in primary care. Evidence-based medicine and development of guidelines offer a means of ensuring a cost-effective approach to this disease. We have evaluated several existing national guidelines for GERD in primary care for their agreement and evidence base, to develop a basis for European guidelines and to detect issues that need further research in this area. Methods: National guidelines were sought in the United Kingdom, Sweden, Norway, Denmark, Germany, the Netherlands and Italy. A Medline and cross-reference literature search was carried out, based on several decision points in the guidelines. Results: Five national guidelines were available; in two countries no national guidelines existed. A good degree of agreement in the national guidelines was generally found on the diagnosis of GERD but guidance on the treatment of GERD varied more, especially with respect to the class and order of drug prescription. In most guidelines, dose and duration of treatment were not mentioned. Evidence was found on various decision points but was insufficient or not available on some points. Conclusions: There was sufficient agreement between the national guidelines and sufficient evidence-based support to provide recommendations for management. However, a number of issues still require further research to ensure a cost-effective and evidence-based approach for the management of GERD in primary care.