In this guideline, the Cascades are listed in sections 3.5, “Cascades for the Diagnosis of GERD” and 4.6, “Cascades for the Management of GERD.”.The WGO cascade approach aims to optimize the use of available health-care resources for individual patients, based on their location and access to various health-care providers. When patients perceive that their symptoms are more troublesome, they may seek a doctor’s advice depending on the patient’s circumstances and the structure of the local health- care system, patients may seek advice at the primary care level or they may consult a gastroenterology specialist or surgeon, directly or by referral.
For initial management, the patient may purchase over-the-counter (OTC) medication for heartburn relief or seek further advice from a pharmacist.
The expression of the disease is considered to be similar across regions, with heartburn and regurgitation as the main symptoms. Practice recommendations should be sensitive to context, with the goal of optimizing care in relation to local resources and the availability of health-care support systems. GERD is now widely prevalent around the world, with clear evidence of increasing prevalence in many developing countries.
WGO Cascades: a hierarchical set of diagnostic, therapeutic, and management options for dealing with risk and disease, ranked by the resources available. The WGO Cascades are intended to serve as a “global” complement to - rather than a replacement for - the “gold standard” guidelines produced by regional groups and national societies. GERD is a condition that is particularly suitable for the WGO cascade approach, and this global WGO guideline therefore includes a set of cascades to provide context-sensitive and resource-sensitive options for the diagnosis and management of GERD. However, neither the epidemiology of the condition, nor the availability of resources for the diagnosis and management of GERD, is sufficiently uniform throughout the world to support the provision of a single, gold standard approach. RELUX DEFINITION FULL
WGO Cascades are thus context-sensitive, and the context is not necessarily defined solely by resource availability.Ī standardized global approach would require that the epidemiology of GERD and reflux-like symptoms be comparable in all parts of the world, and that the full ranges of diagnostic tests and medical treatment options be generally available. It is also important to emphasize to health-care insurers and funding bodies that appropriate, effective therapy is both therapeutic and diagnostic and that conducting mandatory investigations (e.g., esophagogastroduodenoscopy) to permit proton-pump inhibitor (PPI) therapy is not patient-centered and, more importantly, is likely not to be cost-effective. However, one could argue that there are similar problems in developed countries and that an overemphasis on complications or “proposed GERD associations” (as in the Montreal Consensus ) is leading to inappropriate investigations and resource utilization even in developed regions. There is a concern that guidelines from developed countries, by emphasizing high-tech investigations and Barrett’s esophagus (BE) surveillance, for example, may divert research and clinical resources from more urgent problems in developing and semideveloped countries. WGO guidelines are intended to highlight appropriate, context-sensitive and resource- sensitive management options for all geographical regions, regardless of whether they are considered to be “developing,” “semi-developed,” or “developed.” 1.1 Cascades for GERD diagnosis and management The WGO’s aim in the guideline is to guide health-care providers in the best management of gastroesophageal reflux disease (GERD) through a concise document that provides recommendations based on the latest evidence and has been drawn up in a global expert consensus process focusing on the best current practice. This is the second WGO guideline published to complement World Digestive Health Day (WDHD) themes. 
WGO International Meetings Call for Bids.World Congress of Gastroenterology (WCOG).e-WGN Expert Point of View Articles Collection.Gastroenterology Practice in COVID-19 Pandemic.Antibody Testing for SARS-CoV-2: Role in Management of the Disease.Personal Protection Equipment for Endoscopy in Low Resource Settings during the COVID-19 Pandemic: Guidance from the World Gastroenterology Organisation.GI and Liver Manifestations of COVID-19.WGO Guidance for Patients with COVID-19 and liver disease.Message From WGO President, Professor Naima Lahbabi-Amrani.
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