Refractory Gastroesophageal Reflux Disease: A Management Update

Area of Science:

• Gastroenterology
• Pharmacology
• Surgical Innovation

Background:

• Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder.
• Proton pump inhibitors (PPIs) are standard treatment, but up to 40% of patients show inadequate response, leading to refractory GERD (rGERD).
• rGERD significantly impacts quality of life and healthcare costs, with its definition remaining controversial.

Purpose of the Study:

• To review current diagnostic approaches for rGERD.
• To comprehensively outline various medical and surgical management strategies for rGERD.
• To emphasize the need for personalized treatment plans for rGERD.

Main Methods:

• Literature review of diagnostic methods including endoscopy and pH-impedance monitoring.
• Analysis of pharmacological treatments beyond PPIs, such as H2RAs, PCABs, prokinetics, and GABA-B agonists.
• Evaluation of invasive antireflux options including laparoscopic antireflux surgery (LARS) and less invasive procedures like TIF, LINX, and Stretta.

Main Results:

• Objective diagnostic workup is crucial to confirm GERD in PPI-unresponsive patients.
• A range of pharmacologic agents and interventions exist for rGERD management.
• Surgical and endoscopic options offer alternatives when medical therapy fails and GERD is confirmed.

Conclusions:

• Accurate diagnosis is essential to differentiate true rGERD from other conditions.
• Management of rGERD requires a tailored approach, considering various therapeutic options.
• Personalized strategies combining medical and potentially surgical interventions are key to improving outcomes for rGERD patients.