TITLE: CHALLENGES IN MANAGEMENT OF REFRACTORY GASTROESOPHAGEAL REFLUX DISEASE (GERD) IN A RESOURCE LIMITED HOSPITAL SETTING OF A DEVELOPING NATION. afzalanees@gmail.com

 

TITLE: CHALLENGES IN MANAGEMENT OF REFRACTORY GASTROESOPHAGEAL REFLUX DISEASE (GERD) IN A RESOURCE LIMITED HOSPITAL SETTING OF A DEVELOPING NATION.

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India

Oral only

Refractory gastroesophageal reflux disease (GERD) is a significant clinical challenge, defined by persistent GERD symptoms despite optimized proton pump inhibitor therapy. The prevalence of GERD in Indian population ranges from 11% to 20.7% leading to diminished quality of life and substantial burden. While laparoscopic fundoplication (LF) is the established surgical standard , potassium-competitive acid blockers (PCABs) have emerged ; their specific roles in a systematic treatment algorithm require further research.

A prospective series of 73 (P=30% of GERD population, CI=95%, d=0.05) consecutive patients with symptoms of refractory GERD were enrolled; out of 246 patients of GERD (P=20%,CI=95%, d=0.05) over period of 2 years from January 2023 to December 2024. All patients had an objective diagnosis of refractory GERD confirmed by positive impedance-pH monitoring . The study involved an initial 8-week PCAB trial (e.g, fexuprazan). Patients who experienced symptom relief were maintained on PCAB, others were offered LF. Symptom relief was assessed using validated GERD-specific quality of life (GERD-HRQL) questionnaire.

Of the 73 patients, 45% (n=33) achieved significant symptom improvement continuing on PCABs. The remaining 55% (n=40) with persistent symptoms underwent LF. Following LF, 85% (n=34) reported complete resolution and 90% (n=36) were able to discontinue all acid-suppressive medication. The remaining 15% (n=6) reported partial symptom relief requiring intermittent medical management.

This study suggests a structured sequential approach to the management of refractory GERD. This algorithm incorporating PCABs as a bridge between conventional PPI therapy and surgical intervention, provides a clear and effective pathway for managing this challenging subset of population.