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Management of GERD in the Asia Pacific

Management of GERD in the Asia Pacific

20 Aug 2021 14:36 14:48
- Supported by Eisai (12 mins)
Nicholas Talley Speaker
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In 2016, the Asian Pacific Consensus on Management of GERD was published in Gut. This lecture will focus on advances since 2016 in the field. GERD phenotypes have been well described included esophagitis, non-erosive reflux disease, reflux hypersensitivity and functional heartburn. However, functional dyspepsia has not been considered a GERD phenotype, but recent data on the risk of GERD in those with eosinophilic duodenitis, a characteristic finding in functional dyspepsia, challenges the paradigm. Proton pump inhibitors (PPIs) remain the backbone of GERD medical therapy. Potassium competitive acid blockers (PCABs) offer no obvious clinically relevant advantage over PPIs. While studies have reported long-term PPIs may be associated with a number of complications, a randomized controlled trial with 53,152 patient-years of follow-up over 3 years indicated only enteric infections were increased in PPI users, a reassuring result. The management of refractory heartburn remain problematic; neuromodulators provide limited benefits and a double dose PPI has been of uncertain benefit. A randomized controlled trial of anti-reflux surgery versus medical therapy versus no intervention in VA patients from the USA with refractory GERD is practice changing. The results indicate, in contrast to standard teaching, patients with reflux hypersensitivity (documented on esophageal pH metry) have an excellent response to anti-reflux surgery (2/3 respond) compared with a limited response to combination medical therapy (<1/3 respond). However, surgery should only be considered in very carefully selected cases with severe refractory GERD symptoms who have definitely failed medical therapy. Achalasia may be misdiagnosed as refractory GERD, and the new Chicago classification 4.0 esophageal motility disorders has been published. Finally, new approaches to refractory GERD management supported by clinical trials include teaching diaphragmatic breathing for reflux.

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