Management of Patients With Refractory Reflux-Like Symptoms Despite Proton Pump Inhibitor Therapy: Evidence-Based...

Area of Science:

• Gastroenterology
• Clinical Practice Guidelines
• Refractory GERD Management

Background:

• Many patients with gastro-oesophageal reflux disease (GERD) experience persistent symptoms even with proton pump inhibitor (PPI) therapy.
• Refractory reflux-like symptoms (rRLS) present a significant clinical challenge.

Purpose of the Study:

• To establish evidence-based statements for clinicians managing patients with refractory reflux-like symptoms (rRLS) or refractory GERD.
• To guide the diagnosis and treatment optimization for patients with persistent GERD symptoms.

Main Methods:

• Developed by the International Working Group for the Classification of Oesophagitis.
• Utilized systematic literature reviews and the GRADE approach for evidence rating.
• Focused on PICO questions regarding the management of PPI-refractory rRLS.

Main Results:

• Consensus reached on 13 of 17 diagnostic and management statements for rRLS.
• Suggested diagnostic strategies include endoscopy, ambulatory reflux testing, and oesophageal manometry.
• Advised against increasing PPI dosage beyond 8 weeks of twice-daily use; suggested alginate or antacid therapy.

Conclusions:

• Personalized management of rRLS is crucial, involving shared decision-making on diagnostic testing.
• Objective confirmation of GERD is necessary before considering anti-reflux procedures.
• Treatment optimization should be based on confirmed GERD diagnosis.