Provider Variability in the Management Patterns of Increased Nonacid Reflux

Area of Science:

• Gastroenterology
• Digestive Health
• Reflux Disease Management

Background:

• Increased nonacid reflux is diagnosed in a subset of GERD patients with refractory symptoms.
• Management strategies for nonacid reflux are often unclear and inconsistent.

Purpose of the Study:

• To investigate physician management patterns for patients diagnosed with increased nonacid reflux via impedance-pH studies.

Main Methods:

• Retrospective review of reflux studies and management approaches in patients meeting Lyon Consensus criteria for nonacid reflux.
• Assessment of reflux symptom association (RSA), manometry, and immediate post-testing management decisions.

Main Results:

• Gastroenterologists managed 95% of cases, with significant variation in treatment plans.
• No change in management was the most common approach, even with positive reflux symptom association (RSA).
• Baclofen was the most frequent medication change, while visceral hypersensitivity drugs and surgery were rare.

Conclusions:

• Increased nonacid reflux is common on impedance-pH studies, but management is inconsistent among gastroenterologists.
• Treatment changes, when made, are variable, including lifestyle, medications, or surgery.
• Standardized management algorithms are needed for increased nonacid reflux.