Evidence map›Paper›PMID 39740235›Full record

ArticleAlimentary pharmacology & therapeutics2025

Management of Patients With Refractory Reflux-Like Symptoms Despite Proton Pump Inhibitor Therapy: Evidence-Based Consensus Statements.

David Armstrong, A Pali Hungin, Peter J Kahrilas, Daniel Sifrim, Paul Moayyedi, Michael F Vaezi, Sameer Al-Awadhi, Sama Anvari, Reginald Bell, Brendan Delaney and 16 more

Abstract readConsensus Statement
PubMed Full text at PMC Publisher
In one paragraph

Article in Alimentary pharmacology & therapeutics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

  1. Optimizing Evaluation of Gastroesophageal Reflux With Atypical Symptoms: Cost-Effectiveness and Cost-Minimalization Analysis.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

26 authors.

David ArmstrongDivision of Gastroenterology & Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.ORCID https://orcid.org/0000-0003-2487-1479
A Pali HunginFaculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.ORCID https://orcid.org/0000-0001-7275-8927
Peter J KahrilasDivision of Gastroenterology, Northwestern University, Chicago, Illinois, USA.ORCID https://orcid.org/0000-0002-8260-1250
Daniel SifrimBarts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.ORCID https://orcid.org/0000-0002-4894-0523
Paul MoayyediDivision of Gastroenterology & Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.ORCID https://orcid.org/0000-0002-3616-9292
Michael F VaeziDivision of Gastroenterology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.ORCID https://orcid.org/0000-0003-3179-0212
Sameer Al-AwadhiDepartment of Gastroenterology, Rashid Hospital, Dubai Academic Health Corporation, Dubai, UAE.ORCID https://orcid.org/0000-0002-1611-3451
Sama AnvariDivision of Gastroenterology & Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.ORCID https://orcid.org/0000-0002-7284-8735
Reginald BellInstitute of Esophageal and Reflux Surgery, Englewood, Colorado, USA.ORCID https://orcid.org/0000-0002-7912-4000
Brendan DelaneyDepartment of Surgery and Cancer, Imperial College London, Saint Mary's Campus, London, UK.ORCID https://orcid.org/0000-0002-3518-0131
Fabian EmuraDigestive Health and Liver Diseases, Miller School of Medicine, University of Miami, Miami, Florida, USA.
C Prakash GyawaliDivision of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA.ORCID https://orcid.org/0000-0002-3388-0660
Peter KatelarisGastroenterology Department, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia.ORCID https://orcid.org/0000-0001-6969-4328
Adriana LazarescuDivision of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.ORCID https://orcid.org/0000-0002-0464-2217
Yeong Yeh LeeGI Function & Motility Unit, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia.ORCID https://orcid.org/0000-0002-6486-7717
Alessandro RepiciDepartment of Gastroenterology, IRCCS Istituto Clinico Humanitas, Rozzano (Milano), Italy.ORCID https://orcid.org/0000-0002-1621-6450
Sabine RomanDivision of Digestive Physiology, Centre Hospitalier Universitaire de Lyon, Lyon, France.ORCID https://orcid.org/0000-0002-7798-7638
Ceciel T RookerInternational Foundation for Functional Gastrointestinal Disorders (IFFGD), Mount Pleasant, South Carolina, USA.
Edoardo Vincenzo SavarinoGastroenterology Unit, Azienda Ospedale Università di Padova, Padova, Italy.ORCID https://orcid.org/0000-0002-3187-2894
Paul SinclairINSINC Consulting Inc., Guelph, Ontario, Canada.ORCID https://orcid.org/0000-0003-1085-1645
Kentaro SuganoDivision of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi-ken, Japan.ORCID https://orcid.org/0000-0002-8578-2974
Rena YadlapatiDivision of Gastroenterology, University of California San Diego, La Jolla, California, USA.ORCID https://orcid.org/0000-0002-7872-2033
Yuhong YuanDivision of Gastroenterology & Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.ORCID https://orcid.org/0000-0003-4374-3042
Frank ZerbibCHU de Bordeaux, Centre Médico-Chirurgical Magellan, Hôpital Haut-Levêque, Department of Gastroenterology, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France.ORCID https://orcid.org/0000-0002-6802-2121
Prateek SharmaDivision of Gastroenterology and Hepatology, University of Kansas School of Medicine, and Kansas City VA Medical Center, Kansas City, Missouri, USA.ORCID https://orcid.org/0000-0001-5646-8727
International Working Group for the Classification of Oesophagitis (IWGCO)

Funding

The MVP Trial: A Randomized Controlled Trial of Mechanism Guided vs PPI Strategy for Laryngopharyngeal RefluxR01DK139089 · NIDDK · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI Rena Hiren Yadlapati · 2024 to 2026
$2.0M
Mechanism Guided Therapy for Laryngopharyngeal RefluxK23DK125266 · NIDDK · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI YADLAPATI, RENA HIREN · 2021 to 2025
$963k
Independent educational grants to the IWGCO from Cinclus Pharma, Ironwood Pharmaceuticals, and Phathom PharmaceuticalsNIDDK NIH HHS K23 DK125266NIDDK NIH HHS R01 DK139089
6 · The paper itself

Abstract

backgroundMany patients diagnosed with gastro-oesophageal reflux disease (GERD) have persistent symptoms despite proton pump inhibitor (PPI) therapy.

aimsThe aim of this consensus is to provide evidence-based statements to guide clinicians caring for patients with refractory reflux-like symptoms (rRLS) or refractory GERD.

methodsThis consensus was developed by the International Working Group for the Classification of Oesophagitis. The steering committee developed specific PICO questions pertaining to the management of PPI rRLS. Methodologists conducted systematic reviews of the literature. The quality of evidence and strength of recommendations were rated using the GRADE approach.

resultsConsensus was reached on 13 of 17 statements on diagnosis and management. For rRLS, suggested diagnostic strategies included endoscopy, ambulatory reflux testing and oesophageal manometry. The group did not reach consensus on the role of oesophageal biopsies or the use of reflux-symptom association in patients undergoing reflux testing. The group suggested against increasing the PPI dose in patients who had received 8 weeks of a twice-daily PPI. Adjunctive alginate or antacid therapy was suggested. There was no consensus on the role of adjunctive prokinetics. There was little role for adjunctive transient lower oesophageal sphincter relaxation (TLESR) inhibitors or bile acid sequestrants. Endoscopic or surgical anti-reflux procedures should not be performed in patients with rRLS in the absence of objectively confirmed GERD.

conclusionsThe management of rRLS should be personalised, based on shared decision-making regarding the role of diagnostic testing to confirm or rule out GERD as a basis for treatment optimisation. Anti-reflux procedures should not be performed without objective confirmation of GERD.

Indexed as

Gastroesophageal RefluxProton Pump InhibitorsEvidence-Based MedicineHumansManometryProton Pump Inhibitorsendoscopygastro‐oesophageal reflux disease (GERD)GRADEmanometrypH‐impedancerefractory

Identifiers

PMID39740235
PMCPMC11754941

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.