Indian consensus on gastroesophageal reflux disease in adults: A position statement of the Indian Society of Gastroenterology

Bhatia, Shobna; Makharia, Govind; Abraham, Philip; Bhat, Naresh; Kumar, Ajit; Reddy, D. Nageshwar; Ghoshal, Uday C; Ahuja, Vineet; Rao, Guduru Venkat; Devadas, Krishnadas; Dutta, Amit Kumar; Jain, Abhinav; Kedia, Saurabh; Dama, R.; Kalapala, Rakesh; Alvares, Jose Filipe; Dadhich, Sunil; Dixit, Vinod Kumar; Goenka, Mahesh Kumar; Goswami, Bhabhadev; Issar, Sanjeev Kumar; Leelakrishnan, Venkatakrishnan; Mallath, Mohandas K.; Mathew, Philip; Mathew, Praveen; Nandwani, Subhashchandra; Pai, C. Ganesh; Peter, Lorance; Prasad, Anand; Singh, Devinder Kaur Ajit; Sodhi, Jaswinder Singh; Sud, Randhir; Venkataraman, Jayanthi; Midha, Vandana; Bapaye, Amol; Dutta, Usha; Jain, Ajay; Kochhar, Rakesh; Puri, Amarender Singh; Singh, Shivram Prasad; Shimpi, Lalit; Sood, Ajit; Wadhwa, Rajkumar T

doi:10.1007/s12664-019-00979-y

Cited by 30 publications

(23 citation statements)

References 241 publications

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“…At its core, GERD is the reflux of gastric content into the esophagus leading to symptoms, complications, or both. This broad categorization, previously proposed by the Montreal Consensus [2], has now been endorsed by the Indian Consensus [1]. Both groups acknowledge that body habitus influences reflux burden.…”

Section: Similaritiesmentioning

confidence: 95%

“…Attitudes toward and comfort with GERD diagnosis and management also vary across regions, as is evident from the Indian Consensus [1]. There was very high agreement among Indian opinion leaders for the standard definition of GERD, for epidemiologic risk factors including obesity, and for the significance of GERD in affecting quality of life.…”

Section: Variationsmentioning

confidence: 99%

“…Some of the important concepts that should guide the approach to GERD are highlighted in the Indian Consensus [1]. A therapeutic trial of acid suppressants when careful history suggests GERD [45] is not only easily available, safe, and clinically effective [46,47] but also cost-effective in the absence of alarm symptoms [48].…”

Section: Initial Approach To Gerdmentioning

confidence: 99%

“…A pragmatic investigation protocol can augment precision management, typically when symptoms do not respond to initial acid suppressive therapy (persistent symptoms) or when esophageal symptoms in the context of proven GERD persist despite therapy (refractory GERD). The Indian Consensus emphatically agreed that symptoms do not correlate with objective evidence of GERD [1]. The role of esophageal hypersensitivity and functional dyspepsia in driving persistent foregut symptoms influences the approach to the symptomatic patient [62]; three-quarters of the Indian opinion leaders agreed with this.…”

Section: Diagnostic Evaluationmentioning

confidence: 99%

“…Wireless pH monitoring, routinely utilized in the USA, allows for monitoring up to 96 h, which is useful in patients intolerant of catheters, with infrequent symptoms or with day-to-day variation in acid burden [71]. Yet this is not part of standard practice in India and was felt of limited utilization in the Indian Consensus [1]. There is a growing body of literature suggesting HRM can complement standard diagnostic techniques in predicting GERD [20].…”

Section: Diagnostic Evaluationmentioning

confidence: 99%

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Why differences between New York and New Delhi matter in approach to gastroesophageal reflux disease

Rogers

Gyawali

2019

Indian J Gastroenterol

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Despite rising worldwide prevalence of gastroesophageal reflux disease (GERD), conclusive diagnosis of clinically significant GERD remains elusive, both in New York and in New Delhi. GERD is unique in that diagnosis and management are pursued simultaneously, and indeed, the same diagnostic approach can also be therapeutic, e.g. the proton pump inhibitor (PPI) trial. Currently available tools for GERD diagnosis rely on subjective clinical historyorquestionnairedata,complementedbyobjectivemeasuresof macroscopic and microscopic mucosal integrity, reflux burden, and esophageal pathophysiology. Consequently, GERD management is nuanced and tailored based on patient factors and each physician's approach to diagnosis, which is unique to each region of the world. However, these diagnostic modalities alone are insufficient for a conclusive diagnosis and must be performed and interpreted within the clinical context, with the understanding that gray areas exist. A multipronged approach increases diagnostic confidence but also requires the insight of the treating physician in choosing the diagnostic and management approach appropriate for each part of the world, hence our heavy reliance on informed consensus opinions from regional thought leaders, which is what the Indian Consensus on GERD provides [1].

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Section: Similaritiesmentioning

confidence: 95%

Section: Variationsmentioning

confidence: 99%

Section: Initial Approach To Gerdmentioning

confidence: 99%

Section: Diagnostic Evaluationmentioning

confidence: 99%

Section: Diagnostic Evaluationmentioning

confidence: 99%

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Why differences between New York and New Delhi matter in approach to gastroesophageal reflux disease

Rogers

Gyawali

2019

Indian J Gastroenterol

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Prevalence, risk factors, and healthcare‐seeking among subjects with esophageal symptoms: A community‐based study in a rural Bangladeshi population

Rahman¹,

Ghoshal

Kibria³

et al. 2020

JGH Open

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Background and Aim As there is a scarcity of data on overall prevalence, risk factors, and health‐care utilization of esophageal symptoms using the Rome criteria in the rural population in Asia, we undertook a study with the aims to evaluate: (i) the prevalence of heartburn, chest pain, globus, and dysphagia of presumed esophageal origin; (ii) the prevalence of functional esophageal disorders by Rome III criteria; (iii) the risk factors for esophageal symptoms; and (iv) the health‐care utilization. Methods This door‐to‐door survey was conducted in three villages (Charcharia, Churain of Dhaka district, and Kharrah of Munshiganj district of Bangladesh) among the adult population (≥18 years) using the translated and validated Enhanced Asian Rome III questionnaire. Results Of 3559 individuals, 3351 (94.15%) responded (mean age 40.41 ± 16.04 years, female, 1924 [57.4%]). Heartburn was the most common symptom, 863 (25.8%), followed by chest pain, 367 (11%); globus, 285 (8.5%); and dysphagia, 146 (4.4%). At least one symptom was present in 1108 (33.1%) respondents. Based on Rome III criteria, 428 (12.8%), 41 (1.2%), 49 (1.5%), 26 (0.8%), and 524 (15.6%) had heartburn, chest pain, globus, dysphagia, and at least one functional esophageal disorder, respectively. Female gender, lower family income, presence of functional dyspepsia‐irritable bowel syndrome (FD‐IBS) overlap, FD only, and psychological distress were found to be risk factors for esophageal symptoms on multivariate analysis. Among the subjects with any esophageal disorders, 156 (14.1%) consulted any health‐care provider, and 517 (46.6%) took antisecretory medications. Conclusion Esophageal symptoms are common in the rural community of Bangladesh and are associated with substantial health resource utilization.

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Efficacy and safety of pantoprazole and itopride in patients with overlap of gastroesophageal reflux disease and dyspepsia: A prospective, open‐label, single‐arm pilot study

Lakhtakia,

Singh,

Singla

et al. 2024

JGH Open

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Background and AimCombining proton pump inhibitors (PPIs) with prokinetics can provide synergistic action in patients with gastroesophageal reflux disease (GERD) and overlapping dyspepsia, but data regarding this is lacking.MethodsThis single‐center, prospective study evaluated the efficacy and safety of 6‐week treatment with fixed‐drug combination (FDC) of pantoprazole (PPI) and itopride (prokinetic) in 50 patients with ≥3 month history of GERD and overlapping dyspepsia refractory to pantoprazole. Efficacy was assessed as reduction in GERD symptom assessment scale (GSAS) distress score for 15 symptoms from baseline to week 6. Adverse events (AEs) were monitored up to week 6.ResultsAlthough heartburn was the most common symptom at week 6 (26.8%), its frequency significantly decreased from baseline (84.0%; P <0.01). A similar trend was observed for other symptoms: pressure/discomfort inside chest (19.5%), belching (14.6%), regurgitation (12.2%), bloating (9.8%), flatulence (9.8%), early satiety (7.3%), acidic/sour taste in mouth (7.3%), nausea (7.3%), frequent gurgling in stomach/belly (4.9%), and pressure/lump in throat (2.4%). Mean distress scores of all symptoms markedly decreased at week 6. Three AEs (n = 2) of moderate intensity were reported.ConclusionThe FDC of pantoprazole and itopride showed favorable efficacy and safety in patients with GERD and overlapping dyspepsia refractory to pantoprazole monotherapy. Nevertheless, further studies are warranted.

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Indian consensus on gastroesophageal reflux disease in adults: A position statement of the Indian Society of Gastroenterology

Cited by 30 publications

References 241 publications

Why differences between New York and New Delhi matter in approach to gastroesophageal reflux disease

Why differences between New York and New Delhi matter in approach to gastroesophageal reflux disease

Prevalence, risk factors, and healthcare‐seeking among subjects with esophageal symptoms: A community‐based study in a rural Bangladeshi population

Efficacy and safety of pantoprazole and itopride in patients with overlap of gastroesophageal reflux disease and dyspepsia: A prospective, open‐label, single‐arm pilot study

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