Learn from Women in GI (On-Demand) | September 2021-Managing Refractory GERD Symptoms: What to do Next?

Video Transcription

Video Summary

The video is an introductory webinar on managing refractory gastroesophageal reflux disease (GERD) symptoms. Ed Dellert from the American Society for Gastrointestinal Endoscopy (ASGE) introduces the webinar and discusses the features of the webinar platform. Drs. Michael Smith and Kimberly Cavalieri then present on the management of refractory GERD symptoms.<br /><br />Dr. Smith explains the causes of GERD and discusses treatment goals, including symptom elimination and esophagitis healing. He covers various medical treatment options and emphasizes the superior efficacy of proton pump inhibitors (PPIs). Dr. Smith also addresses common concerns about PPI use.<br /><br />He outlines his approach to managing refractory GERD, emphasizing the importance of assessing patient compliance, risk stratification, and diagnostic tests. Dr. Smith concludes by stressing the need for individualized management plans and considering other potential diagnoses.<br /><br />The video also discusses various treatment options for managing GERD, including sodium alginate and sucralfate in combination with meals. Anatomic interventions, such as surgery and endoscopic approaches, are mentioned. The importance of combination therapy and recognizing the paradigm shift in treatment options is highlighted. An ideal candidate for an anatomic intervention is someone with well-controlled symptoms on PPIs.<br /><br />Indications for anatomic interventions are refractory esophagitis, volume regurgitation, aspiration symptoms, and persistent symptoms caused by refractory GERD. The Nissen fundoplication is the main anatomic intervention, while the Toupet fundoplication is preferred for patients with esophageal dysmotility. Roux-en-Y gastric bypass is mentioned for obese patients with significant acid reflux.<br /><br />Endoscopic interventions, such as magnetic sphincter augmentation and transoral incisionless fundoplication, are discussed, with evolving guidelines for endoscopic therapy. These interventions may be considered in patients who are not surgical candidates or have comorbidities. The focus is on individualizing treatment based on patient characteristics and optimizing outcomes.

Asset Subtitle

Kimberly Cavaliere, MD

Keywords

refractory GERD

symptom management

PPIs

medical treatment

patient compliance

risk stratification

diagnostic tests

individualized management

sodium alginate

sucralfate

anatomic interventions

endoscopic approaches

combination therapy

acid reflux