2025 American Guidelines for GERD: A Complete Patient Guide

 
Gastroesophageal reflux disease (GERD) is among the most common gastrointestinal (GI) disorders, particularly in developed countries. It affects up to one-third of adults in the United States and can significantly reduce quality of life. Left untreated, GERD can lead to serious complications and frequent healthcare visits.
 
In 2025, the American Society for Gastrointestinal Endoscopy (ASGE) released new, evidence-based guidelines for GERD diagnosis and management. This article summarizes the key updates in a clear, patient-friendly format.


What Is GERD (Gastroesophageal Reflux Disease)?
GERD is a chronic condition where stomach acid flows backward into the esophagus. This causes common symptoms like heartburn and regurgitation. Over time, GERD may result in:

• Erosive esophagitis
• Peptic stricture (esophageal narrowing)
• Barrett’s esophagus (BE) – a precancerous change in the esophagus lining
• Esophageal adenocarcinoma (a type of cancer)

 
GERD can also affect infants and children, though diagnosis may be more challenging due to their inability to describe symptoms.


Why the 2025 American Guidelines Matter
The updated ASGE guidelines reflect new clinical evidence and emerging technologies. They emphasize tailored approaches for patients with:

• History of bariatric surgery, especially sleeve gastrectomy (SG)
• Prior peroral endoscopic myotomy (POEM) for achalasia
• Need for advanced endoscopic anti-reflux procedures, such as:
  • TIF (Transoral Incisionless Fundoplication)
  • Radiofrequency therapy

 
When Should GERD Patients Get an Endoscopy?
Endoscopy Is Recommended If You Have:

• Alarm symptoms: difficulty or painful swallowing, weight loss, vomiting, GI bleeding, or anemia
• Risk factors for Barrett’s esophagus:
  • Age over 50
  • Male sex
  • White race
  • Obesity
  • Smoking
  • Family history of BE or esophageal cancer
• Children or infants showing red flags like poor weight gain or frequent regurgitation

 
Post-Surgery Endoscopy Recommendations
After Sleeve Gastrectomy:

• Symptomatic patients: Endoscopy is suggested.
• Asymptomatic patients: Routine endoscopy at 3 years post-op, then every 5 years.

 
After peroral endoscopic myotomy (POEM):

• With reflux symptoms: Endoscopy is suggested.
• Without symptoms: Periodic endoscopic surveillance should still be considered.

 
What Defines a High-Quality GERD Endoscopy?
According to ASGE, a GERD endoscopy should include:

• Documentation of findings: erosive esophagitis, BE, or strictures
• Detailed description of the gastroesophageal junction anatomy
• Photo documentation for accurate diagnosis and follow-up planning

 
Lifestyle Changes for GERD Symptom Relief
Non-medication approaches remain first-line therapy:

• Lose weight if overweight or obese
• Stop smoking
• Avoid meals within 3 hours of bedtime
• Raise the head of your bed to prevent nighttime reflux

 
Medications: The Role of Proton Pump Inhibitors (PPIs)
PPIs are highly effective in reducing stomach acid and controlling GERD. The updated guidance recommends:

• Using the lowest effective dose for the shortest necessary duration
• Considering pharmacogenomic testing (e.g., CYP2C19 gene) for patients who respond poorly
• Avoiding long-term use unless needed, due to risks like enteric infections

 
New Endoscopic Therapies for GERD: What’s Available
TIF (Transoral Incisionless Fundoplication)
A minimally invasive option for patients who:

• Have had GERD symptoms for over 6 months
• Have a small hiatal hernia (≤2 cm)
• Want to avoid long-term medications
• Experience regurgitation-dominant GERD

 
cTIF (Combined Hiatal Hernia Repair + TIF)
For patients with larger hiatal hernias (>2 cm) and persistent reflux. Treatment should involve a multidisciplinary team for best outcomes.


Radiofrequency Therapy
For select patients with a small hiatal hernia and confirmed GERD, this therapy can be considered when other options are not suitable.


Comprehensive GERD Care at Bumrungrad International Hospital
At the GI & Liver Center at Bumrungrad International Hospital, we offer a full range of GERD diagnosis and treatment options. Our internationally trained team includes:

• Advanced endoscopists
• Motility experts
• Minimally invasive and foregut surgeons
• Pathologists and radiologists

We are also the first center in Southeast Asia to offer the TIF procedure, delivering innovative care for patients seeking non-surgical GERD solutions.
Our services include:

• High-quality endoscopic GERD evaluations
• Advanced motility and diagnostic testing
• Minimally invasive surgery
• Precision-guided treatment planning

 
Managing GERD with Confidence
The 2025 American GERD guidelines provide better clarity and options for both patients and providers. If you frequently experience heartburn, regurgitation, or digestive discomfort, don’t ignore the symptoms.

Early diagnosis and proper treatment can prevent complications and restore your quality of life. Take control of your reflux—schedule your consultation today.
 


Tossapol Kerdsirichairat, MD, FACG, FASGE
Clinical Associate Professor of Medicine
Advanced/Bariatric Endoscopy, Digestive Disease Center
Bumrungrad International Hospital