Fourteen esophagologists used the RAND/UCLA Appropriateness Method to address hypothetical scenarios in which patients previously demonstrated GERD and persistent symptoms despite undergoing double-dose PPI therapy.
Here’s what the study found:
1. When a patient had elevated esophageal acid exposure time, laparoscopic fundoplication was deemed appropriate. Laparoscopic fundoplication was moderately appropriate when patients had positive symptom-reflux association for regurgitation and a large hiatal hernia with normal EAE.
2. Esophagologists deemed magnetic sphincter augmentation was moderately appropriate for EAE without a large hiatal hernia.
3. Esophagologists said transoral incisionless fundoplication and radiofrequency energy delivery were not appropriate in any scenario.
4. The esophagologists ranked noninvasive options:
- Histamine2 receptor antagonist for elevated EAE
- Transient lower esophageal sphincter relaxation inhibitors for elevated reflux episodes
- Neuromodulation/cognitive behavioral therapy for positive symptom-reflux association
Researchers concluded, “For treatment of PPI unresponsive symptoms in proven GERD, expert esophagologists recommend invasive therapy only in the presence of abnormal reflux burden, with or without hiatal hernia, or regurgitation with positive symptom-reflux association and a large hiatus hernia. Non-invasive pharmacologic or behavioral therapies are preferred for all other scenarios.”
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