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Knowledge gaps in the management of refractory reflux-like symptoms: Healthcare provider survey

Lookup NU author(s): Emeritus Professor Amritpal Hungin, Dr Paul Sinclair



This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


© 2022 The Authors. Neurogastroenterology & Motility published by John Wiley & Sons Ltd. Background: Refractory reflux-like symptoms have a substantial impact on patients and healthcare providers. The aim of the survey was to qualitatively assess the needs and attitudes of practicing clinicians around the management of refractory reflux symptoms and refractory gastroesophageal reflux disease (rGERD). Methods: An International Working Group for the Classification of Oesophagitis (IWGCO) steering committee invited clinicians to complete an online survey including 17 questions. Key results: Of the 113 clinicians who completed the survey, 70% were GIs, 20% were primary care physicians, and 10% were other specialties. Functional heartburn was considered the most common reason for an incomplete response to proton pump inhibitor (PPI) therapy (82%), followed by stress/anxiety (69%). More GIs identified esophageal hypersensitivity as a cause, while more non-GIs identified esophageal dysmotility and non-reflux-related esophageal conditions. As the first step, most clinicians would order investigations (70–88%). Overall, 72% would add supplemental therapy for patients with partial response, but only 58% for those with non-response. Antacid/alginate was the most common choice overall, while non-GIs were more likely to add a prokinetic than were GIs (47.8 vs. 24.1%). Approximately 40% of clinicians would switch PPIs in patients with partial response, but only 29% would do so in non-responders. Preferences for long-term therapy were highly variable. The most common initial investigation was upper endoscopy. Choice of esophageal manometry and pH monitoring was more variable, with no clear preference for whether pH monitoring should be conducted on, or off, PPI therapy. Conclusions and Inferences: The survey identified a number of challenges for clinicians, especially non-GI physicians, treating patients with refractory reflux-like symptoms or rGERD on a daily basis.

Publication metadata

Author(s): Armstrong D, Hungin AP, Kahrilas PJ, Sifrim D, Sinclair P, Vaezi MF, Sharma P

Publication type: Article

Publication status: Published

Journal: Neurogastroenterology and Motility

Year: 2022

Volume: 34

Issue: 10

Print publication date: 01/10/2022

Online publication date: 03/05/2022

Acceptance date: 11/04/2022

Date deposited: 19/05/2022

ISSN (print): 1350-1925

ISSN (electronic): 1365-2982

Publisher: Wiley-Blackwell Publishing Ltd.


DOI: 10.1111/nmo.14387


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