ASGE Annual Postgraduate Course: Leveraging New Advances to Improve Patient Outcomes (Live and Virtual) | May 2024-Moving Beyond Medical Therapy for Refractory GERD

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Dr. Rena Yadlapati, a Professor of Clinical Medicine at the University of California San Diego, discusses the management of refractory GERD beyond medical therapy. She emphasizes the importance of personalized therapy based on patient preferences and phenotypes. While most GERD patients improve with medical and lifestyle optimization, some may require surgical or endoscopic interventions. Understanding the mechanisms of GERD, including the variability in PPI effectiveness, is crucial for successful treatment.<br /><br />Persistent symptoms despite optimized therapy and objective evidence of refractory GERD, such as esophageal mucosal damage or pathophysiologic acid exposure, may necessitate further testing. It is essential to rule out mimickers of GERD like achalasia and rumination syndrome before considering anti-reflux interventions. Various options exist, including laparoscopic fundoplication, magnetic sphincter augmentation, and transoral incisionless fundoplication, each with benefits and considerations.<br /><br />Dr. Yadlapati also highlights lifestyle modifications, such as weight management and nighttime strategies, as effective in managing GERD symptoms. Adjunctive pharmacotherapy, like H2 receptor antagonists and potassium competitive acid blockers, can also play a role based on patient phenotype. The document presents guidelines for endoscopic and surgical treatments, suggesting considerations for different scenarios, including the use of radiofrequency energy and Roux-en-Y gastric bypass in select cases.<br /><br />In conclusion, the approach to refractory GERD involves a comprehensive evaluation, optimized management strategies, and a tailored treatment plan that may include a range of interventions beyond traditional medical therapy.

Asset Subtitle

Rena H. Yadlapati, MD, MSHS

Keywords

Refractory GERD

Management

Personalized therapy

Surgical interventions

Endoscopic interventions

PPI effectiveness

Esophageal mucosal damage

Achalasia

Lifestyle modifications

Adjunctive pharmacotherapy