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Lookup NU author(s): Emeritus Professor Amritpal Hungin
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).
© 2024 The Author(s). Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.Background: Many patients diagnosed with gastro-oesophageal reflux disease (GERD) have persistent symptoms despite proton pump inhibitor (PPI) therapy. Aims: The aim of this consensus is to provide evidence-based statements to guide clinicians caring for patients with refractory reflux-like symptoms (rRLS) or refractory GERD. Methods: This consensus was developed by the International Working Group for the Classification of Oesophagitis. The steering committee developed specific PICO questions pertaining to the management of PPI rRLS. Methodologists conducted systematic reviews of the literature. The quality of evidence and strength of recommendations were rated using the GRADE approach. Results: Consensus was reached on 13 of 17 statements on diagnosis and management. For rRLS, suggested diagnostic strategies included endoscopy, ambulatory reflux testing and oesophageal manometry. The group did not reach consensus on the role of oesophageal biopsies or the use of reflux-symptom association in patients undergoing reflux testing. The group suggested against increasing the PPI dose in patients who had received 8 weeks of a twice-daily PPI. Adjunctive alginate or antacid therapy was suggested. There was no consensus on the role of adjunctive prokinetics. There was little role for adjunctive transient lower oesophageal sphincter relaxation (TLESR) inhibitors or bile acid sequestrants. Endoscopic or surgical anti-reflux procedures should not be performed in patients with rRLS in the absence of objectively confirmed GERD. Conclusions: The management of rRLS should be personalised, based on shared decision-making regarding the role of diagnostic testing to confirm or rule out GERD as a basis for treatment optimisation. Anti-reflux procedures should not be performed without objective confirmation of GERD.
Author(s): Armstrong D, Hungin AP, Kahrilas PJ, Sifrim D, Moayyedi P, Vaezi MF, Al-Awadhi S, Anvari S, Bell R, Delaney B, Emura F, Gyawali CP, Katelaris P, Lazarescu A, Lee YY, Repici A, Roman S, Rooker CT, Savarino EV, Sinclair P, Sugano K, Yadlapati R, Yuan Y, Zerbib F, Sharma P
Publication type: Article
Publication status: Published
Journal: Alimentary Pharmacology and Therapeutics
Year: 2025
Pages: epub ahead of print
Online publication date: 30/12/2024
Acceptance date: 18/11/2024
Date deposited: 14/01/2025
ISSN (print): 0269-2813
ISSN (electronic): 1365-2036
Publisher: John Wiley and Sons Inc
URL: https://doi.org/10.1111/apt.18420
DOI: 10.1111/apt.18420
Data Access Statement: Data sharing is not applicable to this article as no new data were created or analyzed in this study.
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