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ESNM/ANMS consensus paper: Diagnosis and management of refractory gastro‐esophageal reflux disease
Author(s) -
Zerbib Frank,
Bredenoord Albert J.,
Fass Ronnie,
Kahrilas Peter J.,
Roman Sabine,
Savarino Edoardo,
Sifrim Daniel,
Vaezi Michael,
Yadlapati Rena,
Gyawali C.Prakash
Publication year - 2021
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.14075
Subject(s) - gerd , context (archaeology) , refractory (planetary science) , medicine , reflux , proton pump inhibitor , disease , gastroenterology , esophageal disorder , esophageal ph monitoring , intensive care medicine , esophagus , paleontology , physics , astrobiology , biology
Up to 40% of patients with symptoms suspicious of gastroesophageal reflux disease (GERD) do not respond completely to proton pump inhibitor (PPI) therapy. The term “refractory GERD” has been used loosely in the literature. A distinction should be made between refractory symptoms (ie, symptoms may or may not be GERD‐related), refractory GERD symptoms (ie, persisting symptoms in patients with proven GERD, regardless of relationship to ongoing reflux), and refractory GERD (ie, objective evidence of GERD despite adequate medical management). The present ESNM/ANMS consensus paper proposes use the term “refractory GERD symptoms” only in patients with persisting symptoms and previously proven GERD by either endoscopy or esophageal pH monitoring. Even in this context, symptoms may or may not be reflux related. Objective evaluation, including endoscopy and esophageal physiologic testing, is requisite to provide insights into mechanisms of symptom generation and evidence of true refractory GERD. Some patients may have true ongoing refractory acid or weakly acidic reflux despite PPIs, while others have no evidence of ongoing reflux, and yet others have functional esophageal disorders (overlapping with proven GERD confirmed off therapy). In this context, attention should also be paid to supragastric belching and rumination syndrome, which may be important contributors to refractory symptoms.