Knowledge gaps in the management of refractory reflux‐like symptoms: Healthcare provider survey. Issue 10 (3rd May 2022)

• Record Type: Journal Article
• Authors: Armstrong, David; Hungin, Amrit Pali; Kahrilas, Peter J.; Sifrim, Daniel; Sinclair, Paul; Vaezi, Michael F.; Sharma, Prateek
• Is Part Of: Neurogastroenterology & motility. Volume 34:Issue 10(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2022-05-03
• Subjects: gastroesophageal reflux disease -- proton pump inhibitors -- refractory -- resistant -- supplemental therapy; Gastrointestinal system -- Motility -- Periodicals; Gastrointestinal system -- Innervation -- Periodicals; 616.33
• DOI: 10.1111/nmo.14387
• Languages: English
• ISSNs: 1350-1925

Abstract

Abstract: Background: Refractory reflux‐like symptoms have a substantial impact on patients and healthcare providers. The aim of the survey was to qualitatively assess the needs and attitudes of practicing clinicians around the management of refractory reflux symptoms and refractory gastroesophageal reflux disease (rGERD). Methods: An International Working Group for the Classification of Oesophagitis (IWGCO) steering committee invited clinicians to complete an online survey including 17 questions. Key results: Of the 113 clinicians who completed the survey, 70% were GIs, 20% were primary care physicians, and 10% were other specialties. Functional heartburn was considered the most common reason for an incomplete response to proton pump inhibitor (PPI) therapy (82%), followed by stress/anxiety (69%). More GIs identified esophageal hypersensitivity as a cause, while more non‐GIs identified esophageal dysmotility and non‐reflux‐related esophageal conditions. As the first step, most clinicians would order investigations (70–88%). Overall, 72% would add supplemental therapy for patients with partial response, but only 58% for those with non‐response. Antacid/alginate was the most common choice overall, while non‐GIs were more likely to add a prokinetic than were GIs (47.8 vs. 24.1%). Approximately 40% of clinicians would switch PPIs in patients with partial response, but only 29% would do so in non‐responders. Preferences for long‐term therapy were highly variable. The most common initial investigation was upper endoscopy. Choice of esophageal manometry and pH monitoring was more variable, with no clear preference for whether pH monitoring should be conducted on, or off, PPI therapy. Conclusions and Inferences: The survey identified a number of challenges for clinicians, especially non‐GI physicians, treating patients with refractory reflux‐like symptoms or rGERD on a daily basis. Abstract : Top responses among 113 respondents to a healthcare provider survey on the management of refractory reflux‐like symptoms.