ASGE Esophagology: Tailoring Management from Testing to Treatment (Live and Virtual)

Video Transcription
Video Summary
In this video, Dr. Gary Falk discusses the treatment of refractory GERD (gastroesophageal reflux disease). He starts by giving an introduction and thanking the organizers for inviting him. He then outlines the learning objectives for the presentation, which include understanding the definition of refractory GERD, its prevalence, potential causes, diagnostic approaches, and therapeutic approaches.<br /><br />Dr. Falk explains that refractory GERD refers to persisting objective evidence of GERD despite medical therapy, such as erosive esophagitis, abnormal acid exposure, and a high number of reflux events. He also distinguishes between refractory GERD and refractory GERD symptoms, noting that the latter refers to persistent symptoms on stable therapy for eight weeks in someone with prior evidence of reflux.<br /><br />He goes on to discuss the prevalence of refractory GERD, noting that it is a common problem affecting 54% of patients taking once-daily PPIs. He also highlights several factors associated with refractory GERD, including gender, ethnicity, age, BMI, and other gastrointestinal symptoms.<br /><br />Dr. Falk then explores the potential causes of refractory GERD, including mechanical issues at the GE junction, non-compliance with PPI therapy, reflux hypersensitivity, and functional heartburn. He emphasizes the importance of considering these factors when evaluating patients with refractory GERD.<br /><br />Regarding diagnostic approaches, Dr. Falk explains that there is no single test for diagnosing GERD, and it requires piecing together various clinical and test results. He discusses the use of endoscopy, impedance pH testing, high-resolution manometry, and histopathology in diagnosing and phenotyping patients with refractory GERD.<br /><br />In terms of therapy, Dr. Falk highlights non-pharmacological measures, such as weight loss and postural measures, as well as pharmacotherapy options. He discusses the use of alginates for breakthrough symptoms, nocturnal H2 blockers, baclofen for regurgitation or belching, and prokinetics for documented gastroparesis. He also mentions the role of antireflux surgery, TIF procedures, and radiofrequency ablation in selected cases.<br /><br />Dr. Falk concludes by mentioning the potential future use of vonoprazan, a potassium competitive acid blocker, for refractory GERD. He summarizes the key points covered in the presentation and expresses his willingness to answer questions.
Asset Subtitle
Dr. Gary Falk
Keywords
refractory GERD
treatment
GERD
prevalence
diagnostic approaches
therapeutic approaches