Evidence map›Paper›PMID 42247133›Full record

ArticleSurgical endoscopy2026

Genetic variations in medical versus surgical patients with GERD: beyond PPIs and fundoplications.

Abdel-Rahman Naser, Keouna Pather, Erin M Mobley, Masoud Rouhizadeh, Amy M Crisp, Emily J Cicali, Larisa H Cavallari, Jana M Sacco, Ruchir Puri

Abstract readMulticenter StudyComparative Study
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In one paragraph

Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Abdel-Rahman NaserDepartment of Surgery, University of Florida COM Jacksonville, 653 West 8th Street, Jacksonville, FL, 32209, USA.ORCID http://orcid.org/0009-0008-5558-5751
Keouna PatherDepartment of Surgery, University of Florida COM Jacksonville, 653 West 8th Street, Jacksonville, FL, 32209, USA.
Erin M MobleyDepartment of Surgery, University of Florida COM Jacksonville, 653 West 8th Street, Jacksonville, FL, 32209, USA.
Masoud RouhizadehDepartment of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, FL, USA.
Amy M CrispDepartment of Surgery, University of Florida COM Jacksonville, 653 West 8th Street, Jacksonville, FL, 32209, USA.
Emily J CicaliDepartment of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, FL, USA.
Larisa H CavallariDepartment of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, FL, USA.
Jana M SaccoDepartment of Surgery, University of Florida COM Jacksonville, 653 West 8th Street, Jacksonville, FL, 32209, USA.
Ruchir PuriDepartment of Surgery, University of Florida COM Jacksonville, 653 West 8th Street, Jacksonville, FL, 32209, USA. ruchir.puri@jax.ufl.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionGastroesophageal Reflux Disease (GERD) is treated primarily with proton pump inhibitors (PPIs), with surgery reserved for patients refractory to PPIs or with symptomatic hiatal hernias. PPI efficacy depends on metabolism by cytochrome P450 2C19 (CYP2C19) in the liver, which varies with genetic polymorphisms. Rapid (RM) and ultra-rapid (UM) metabolizers may require higher PPI doses for efficacy, while poor (PM) and intermediate (IM) metabolizers respond to lower doses but have higher risk of side effects. This study assesses CYP2C19 phenotype prevalence in medically versus surgically managed GERD. We hypothesized a higher RM/UM rate among surgical patients, suggesting PPI resistance.

methodsThis was a multi-site retrospective cohort study of adult patients with GERD and CYP2C19 genotyping from 2012 to 2023. Medical patients included those with Barrett's esophagus, LA grade C/D esophagitis, or abnormal pH testing. Surgical patients included those who underwent anti-reflux surgery. CYP2C19 phenotypes were grouped as PM/IM, normal metabolizer (NM), and RM/UM based on the anticipated need for PPI dose adjustment. Descriptive statistics were used for analysis.

resultsA total of 261 patients were included in this study: 187 medical (female: 59%, mean age: 57 (SD 15), 77% White) and 74 surgical (female: 69%, mean age: 58 (SD 13), 89% White). Medical patients included the following esophageal pathologies: 52% Barrett's esophagus, 31% abnormal pH testing, and 17% LA grade C/D esophagitis. Surgical patients had a significantly higher proportion of RM/UM phenotypes compared to medical patients (p = 0.018). There was also a significant difference in hiatal hernia size between medical and surgical patients (p < 0.001).

conclusionSurgical patients have a higher prevalence of hypermetabolizing (RM/UM) CYP2C19 phenotypes compared to medical patients. Dose escalation of PPI should be considered in medical patients with these phenotypes, and if ineffective, a timely referral for anti-reflux surgery should be made.

Indexed as

Cytochrome P-450 CYP2C19FundoplicationGastroesophageal RefluxProton Pump InhibitorsAgedDrug ResistanceFemaleGenetic VariationGenotypeHumansMaleMiddle AgedPhenotypeRetrospective StudiesCYP2C19 protein, humanCytochrome P-450 CYP2C19Proton Pump InhibitorsAnti-reflux surgeryCYP2C19Hiatal herniasProton pump inhibitorRefractory GERDResistant GERD

Identifiers

PMID42247133

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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.