TY - JOUR
T1 - ESNM/ANMS consensus paper
T2 - Diagnosis and management of refractory gastro-esophageal reflux disease
AU - Zerbib, Frank
AU - Bredenoord, Albert J.
AU - Fass, Ronnie
AU - Kahrilas, Peter J.
AU - Roman, Sabine
AU - Savarino, Edoardo
AU - Sifrim, Daniel
AU - Vaezi, Michael
AU - Yadlapati, Rena
AU - Gyawali, C. Prakash
N1 - Publisher Copyright:
© 2020 John Wiley & Sons Ltd
PY - 2021/4
Y1 - 2021/4
N2 - 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.
AB - 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.
KW - Barrett's esophagus
KW - esophagitis
KW - gastroesophageal reflux
KW - laparoscopic fundoplication
KW - pH-impedance monitoring
KW - peptic stricture
KW - proton pump inhibitor
UR - http://www.scopus.com/inward/record.url?scp=85098200271&partnerID=8YFLogxK
U2 - 10.1111/nmo.14075
DO - 10.1111/nmo.14075
M3 - Article
C2 - 33368919
AN - SCOPUS:85098200271
SN - 1350-1925
VL - 33
JO - Neurogastroenterology and Motility
JF - Neurogastroenterology and Motility
IS - 4
M1 - e14075
ER -