Building a Comprehensive Rural Anti-Reflux Center

Area of Science:

• Gastroenterology
• Surgical Innovation
• Rural Health

Background:

• Gastroesophageal reflux disease (GERD) is highly prevalent.
• Esophagogastroduodenoscopy (EGD) in rural settings has low diagnostic yield.
• Patients with equivocal EGD findings often require referral to tertiary centers.

Purpose of the Study:

• To establish a comprehensive anti-reflux program in a rural setting.
• To provide diagnostic and therapeutic capabilities for GERD patients locally.
• To assess the feasibility and impact of such a program.

Main Methods:

• Retrospective chart review of 830 GERD patients (August 2015-February 2021).
• Standardized workup included upper GI study, EGD, and wireless pH monitoring.
• High-resolution impedance manometry, gastric emptying scans, and endoFLIP were utilized.

Main Results:

• The study evaluated 830 patients (64.6% female, average age 57.7 years, average BMI 30.8 kg/m²).
• Referrals came from primary care providers, other specialties (pulmonary, surgical), and self-referrals.
• Diverse patient demographics and referral sources highlight community need.

Conclusions:

• Rural surgeons with specialized training can successfully implement comprehensive anti-reflux programs.
• Such programs meet significant community needs and can serve as regional centers.
• These programs are vital for the financial sustainability of rural hospitals.