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THE MONTREAL CONSENSUS AND THE DIAGNOSIS OF GASTROESOPHAGEAL REFLUX DISEASE (GERD):

A CENTRAL AMERICAN NEEDS ANALYSIS
D Armstrong¹, S Gittens², N Vakil³

¹McMaster University, Hamilton, ON; ²ECD Solutions, Atlanta, GA; ³University of Wisconsin Medical School, Milwaukee, WI, USA
BACKGROUND: GERD is very common but there is marked international variation internationally with respect to management. The Montreal Definition and Classification of GERD (Vakil N. Am J Gastroenterol 2006;101:1900) provides a global evidence-based consensus definition and classification for use by patients, physicians and regulatory agencies but acceptance of these recommendations in clinical practice is unknown.
AIM: To evaluate acceptance of the Montreal statements for the diagnosis of GERD by Central American physicians (MDs).
METHODS: A web-based survey (also in paper format) collected demographic data on participants’ specialty, experience and location of practice. Also, 17 multiple choice questions assessed participants’ views on the definition and diagnosis of GERD and its sequelae. The survey was distributed to 450 MDs from Central America in October 2007.
RESULTS: The survey was completed by 361 MDs (GIs: 306, surgeons: 18; residents: 22; other: 15) from the Dominican Republic (139), Guatemala (54), El Salvador (40), Costa Rica (39), Honduras (36), Nicaragua (27) and Panama (26). Most respondents had access to upper GI endoscopy (98.9%; range 97.8-100%) but access to esophageal pH monitoring (44.0; 7.4-75.0), esophageal manometry (36.3; 7.4-61.5), narrow band imaging (10.0; 0.0-30.8) and esophageal impedance monitoring (2.2; 0.0-3.9) was limited and varied between countries. Only 13.3% (5.0-22.2) indicated that a GERD diagnosis could be based on the presence of ‘troublesome’ reflux symptoms; 2.8% (0.0-5.6) would diagnose GERD based on typical symptoms without prior investigation or trial of acid suppression therapy. Most (88.1%; 72.1-90.0) agreed that sleep disturbance occurs in more than 20% of GERD patients.
SUMMARY: Endoscopy is widely available and few respondents diagnose GERD based on patients’ own descriptions of their symptoms.
CONCLUSIONS: Unlike the Montreal Consensus recommendations, many Central American specialists favour an ‘objective’ procedure- or treatment-confirmed strategy rather than a ‘patient-centred’ approach to the diagnosis of GERD. Dissemination of consensus guidelines requires educational interventions to supplement peer-reviewed publication.
Supported by an unrestricted grant from AstraZeneca CAMCAR

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