ASGE Masterclass: Barrett’s Esophagus, GERD and Esophageal Adenocarcinoma (On Demand) | February 2022-The PPI is not working. What's Next? When to consider endoscopic and surgical minimally invasive therapies in GERD

The PPI is not working. What's Next? When to consider endoscopic and surgical minimally invasive therapies in GERD

Video Transcription

Video Summary

In the video, Dr. Thotta discusses the next steps to consider when patients with gastroesophageal reflux disease (GERD) have ongoing symptoms despite proton pump inhibitor (PPI) therapy. She explains that there are different types of refractory GERD, including refractory reflux-like symptoms, refractory GERD symptoms, and refractory GERD itself. Dr. Thotta also provides statistics on the percentage of patients with persistent esophagitis despite PPI therapy based on the grade of esophagitis.<br /><br />She then discusses the potential causes of PPI refractoriness, such as disrupted antireflux barrier, increased transient lower esophageal sphincter relaxations, impaired esophageal clearance, and inadequate acid suppression. Dr. Thotta also mentions other esophageal disorders that can mimic GERD, including eosinophilic esophagitis, achalasia, gastroparesis, and rumination.<br /><br />The video covers various treatment options for refractory GERD, including optimization of PPI therapy, endoscopic therapies (such as Stretta and Transoral Incisionless Fundoplication or TIF), surgical options (such as fundoplication and magnetic sphincter augmentation or LINX procedure), and alternative therapies (such as antireflux mucosectomy and antireflux mucosal ablation).<br /><br />Dr. Thotta provides an overview of these different treatments, including their mechanisms of action, efficacy, potential complications, and long-term outcomes. She also mentions the importance of patient selection and considering factors such as hiatal hernia size, esophageal motility, and comorbidities (such as gastroparesis or achalasia) when deciding on the most appropriate treatment approach.<br /><br />Credits: This video was presented by Dr. Thotta. No other credits were mentioned in the transcript.

Keywords

refractory GERD

PPI therapy

esophagitis

antireflux barrier

esophageal disorders

treatment options

patient selection