Management of refractory typical GERD symptoms

Area of Science:

• Gastroenterology
• Clinical Medicine
• Pharmacology

Background:

• Refractory gastroesophageal reflux disease (rGERD) affects up to 30% of patients with typical GERD symptoms.
• Standard acid-suppressive therapy, including proton pump inhibitors (PPIs), often fails to provide adequate symptom relief.
• Challenges in rGERD management include misdiagnosis, inadequate PPI use, and persistent acid or weakly acidic reflux.

Purpose of the Study:

• To review the current management algorithm for GERD.
• To discuss diagnostic features and management strategies for patients with rGERD.
• To present an updated clinical algorithm for managing rGERD.

Main Methods:

• Review of current GERD management guidelines and published data.
• Discussion of diagnostic approaches, including pH-impedance monitoring (on/off PPI).
• Evaluation of surgical techniques, add-on medical therapies (prokinetics, reflux inhibitors), and agents targeting esophageal sensitivity.

Main Results:

• Exploration of symptom response to various antireflux procedures and medical therapies.
• Consideration of pharmaceutical agents for esophageal hypersensitivity in rGERD.
• Presentation of an expert-opinion-based algorithm for rGERD management.

Conclusions:

• Effective management of rGERD necessitates a comprehensive diagnostic workup to identify underlying causes.
• Treatment strategies should be individualized, incorporating advanced diagnostics and tailored medical or surgical interventions.
• The proposed algorithm integrates diagnostic testing and therapeutic options, including neuromodulators, for improved patient outcomes.