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Vonoprazan in Management of Refractory Gastroesophageal Reflux Disease: An Indian Expert Group Consensus Statements
Philip Abraham1, Gouradas Choudhuri2, Sharad Deshmukh3
1Consultant, Department of Gastroenterology, Hinduja Hospital, Mumbai, Maharashtra, India.
Background:
Approximately, 40% of gastroesophageal reflux disease (GERD) patients experience insufficient symptom relief from proton-pump inhibitors (PPI), resulting in PPI-refractory GERD (rGERD).
Objective:
To review the existing literature and develop an Indian expert group consensus statement on the place of vonoprazan in the management of rGERD.
Materials And Methods:
A panel of 35 leading Indian gastroenterologists extensively reviewed the literature to develop consensus statements for the management of rGERD in Indian patients, with a focus on the newly available potassium-competitive acid blocker (P-CAB), vonoprazan. This process involved two structured meetings in which experts deliberated on literature reviews and draft statements, which were further rigorously discussed and modified. Consensus was achieved through a voting process employing a five-point Likert scale, with results meticulously documented. The final statements unanimously approved by all participants and subsequently developed into a comprehensive manuscript.
Results:
Based on the evidence, 14 statements were developed and confirmed by expert panelists for the assessment and management of rGERD. Among these 14 statements, 5 obtained Level A evidence, 4 received Level B, 4 were classified as Level C, and 1 as Level D. The consensus highlights the importance of symptom assessment, lifestyle modifications, and medication adherence, followed by a diagnostic procedure with upper gastrointestinal (GI) endoscopy. If needed, manometry or 24-hour pH impedance may be considered. Vonoprazan, a novel and reversible potassium-competitive acid blocker (P-CAB), has emerged as a potential alternative to proton pump inhibitors (PPIs), offering rapid, potent, and sustained acid suppression. Based on current evidence, a daily dose of 20 mg vonoprazan for 4-8 weeks is recommended as an initial treatment strategy for rGERD.
Conclusion:
The consensus endorses the use of vonoprazan to improve patient outcomes and quality of life, highlighting its important place in therapy for controlling rGERD in Indian patients.
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