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

David Armstrong; Amrit Pali Hungin; Peter J. Kahrilas; Daniel Sifrim; Paul Sinclair; Michael F. Vaezi; Prateek Sharma

doi:10.1111/nmo.14387

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

David Armstrong^*, Amrit Pali Hungin, Peter J. Kahrilas, Daniel Sifrim, Paul Sinclair, Michael F. Vaezi, Prateek Sharma

^*Corresponding author for this work

Medicine, Gastroenterology Division

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

Abstract

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.

Original language	English (US)
Article number	e14387
Journal	Neurogastroenterology and Motility
Volume	34
Issue number	10
DOIs	https://doi.org/10.1111/nmo.14387
State	Published - Oct 2022

Funding

Armstrong: Institutional research grants from Nestlé Health Sciences, Canadian Association of Gastroenterology and Weston Family Foundation; consultant fees from Canadian Partnership Against Cancer; payment or honoraria for lectures from Fresenius‐Kabi, Viatris and Takeda; support for meeting attendance from the European Commission Initiative on Colorectal Cancer; patents for AI VALI Inc.; advisory board participation for Cinclus Pharma (unremunerated), Phathom Pharma (unremunerated), and Takeda Canada; and served as President of the Canadian Association of Gastroenterology, Treasurer of the International Working Group Classification Oesophagitis, and board member of the Canadian Digestive Health Foundation. Hungin: Payment for advisory board participation for Reckitt Benckiser; served as a Committee Member for the UK and European Primary Care Societies for Gastroenterology, and as Chair or the Primary Care Committee for the ROME Foundation for Functional GI Disorders. Kahrilas: Grants or contracts from the US Public Health Service (P01 DK117824); royalties for patent (FLIP); consulting fees from Reckitt Benckiser, Johnson & Johnson, and Ironwood Pharmaceuticals; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Johnson & Johnson and Reckitt Benckiser; patent issuance for FLIP; and has served as President of the American Foregut Society. Sifrim: Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Reckitt Benckiser UK, Jinshan Technology (China), Alfa Sigma (Italy); and receipt of equipment, materials, drugs, medical writing, gifts, or other services from Reckitt Benckiser UK, Jinshan Technology (China), Alfa Sigma (Italy). Sinclair: None. Vaezi: Grants or contracts from Diversatek; royalties or licenses from Diversatek; consulting fees from Ironwood Pharmaceuticals, IsoThrive, Sanofi, Bayer Phathom, Medtronic, and Diversatek, and for consultation related to litigation concerning acid suppressive therapy; payment for expert testimony related to litigation concerning acid suppressive therapy; patent for mucosal integrity testing; served as Associate Editor for Gastroenterology (AGA). Sharma: Grants or contracts from Cosmo Pharmaceuticals, Covidien, Salix, Fujifilm Holdings America Corporation, Medtronic USA, Inc. Docbot, ERBE USA, Inc., Olympus, US Endoscopy Ironwood Pharmaceuticals, Inc.; and consulting fees from Bausch, Boston Scientific Corporation, Exact Sciences, Lucid, Lumendi, Medtronic, CDx Labs, Covidien LP, Fujifilm Medical Systems USA, Inc. No external funding was obtained. The medical writers were supported by the IWGCO

Keywords

gastroesophageal reflux disease
proton pump inhibitors
refractory
resistant
supplemental therapy

ASJC Scopus subject areas

Endocrine and Autonomic Systems
Gastroenterology
Physiology

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10.1111/nmo.14387

Cite this

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title = "Knowledge gaps in the management of refractory reflux-like symptoms: Healthcare provider survey",

abstract = "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.",

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

Abstract

Funding

Keywords

ASJC Scopus subject areas

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