'Unmasking Endoscopic Patterns in PPI-Refractory GERD: Insights into Findings and Risk Factors'

Aims This study aims to evaluate endoscopic findings in patients with gastroesophageal reflux disease (GERD) who continue to experience symptoms despite proton pump inhibitor (PPI) treatment, and to identify lifestyle and dietary factors potentially contributing to refractory GERD.

Methods This prospective cross-sectional study was conducted over one year, from 1^st July 2023 to 30^th June 2024, on 200 patients diagnosed with GERD who exhibited persistent symptoms despite PPI therapy. The cohort included 120 males and 80 females. Typical GERD symptoms, such as heartburn, chest pain, sour taste, sensation of a lump, and sore throat, were recorded. Upper gastrointestinal endoscopy was performed on all patients, with additional esophageal manometry suggested for those showing normal endoscopy results. Risk factors such as high consumption of spicy foods, carbonated drinks, large meal portions, late-night eating, and frequent NSAID use were also assessed [1] [2].

Results Among the 200 patients, predominant symptoms included heartburn (60 patients), chest pain (20), and burping (18). Endoscopic findings revealed hiatal hernia in 65 patients, esophagitis in 34, benign peptic stricture in 16, lax lower esophageal sphincter (LES) in 24, Barrett’s esophagus in 6, and esophageal growth in 3 patients. Interestingly, 52 patients exhibited normal endoscopic findings and were referred for manometric assessment. Key lifestyle risk factors identified included frequent intake of spicy foods, soft drinks, large meal portions, late-night eating, and unmonitored NSAID usage.

Conclusions In patients with GERD refractory to PPI treatment, endoscopic abnormalities such as hiatal hernia, esophagitis, and lax LES are common, indicating structural or inflammatory etiologies in many cases. However, a significant subset showed normal endoscopy, suggesting that motility disorders may contribute to persistent symptoms. The findings emphasize lifestyle modifications as potential interventions to improve GERD outcomes in patients unresponsive to PPI therapy.

Publication History

Article published online:
27 March 2025

• References

• 1 Simadibrata DM, Lesmana E, Fass R.. Role of endoscopy in gastroesophageal reflux disease Daniel. Clinical Endoscopy 2023; 56 (6): 681-692
• 2 Refractory gastroesophageal reflux disease (GERD): A clinical, endoscopic, and histopathological perspective –a single centre cross-sectional study,Somnath Verma a, P. Padmanabhan b, Bhavishya Sundar b, N. Dinakaran b Gastroenterology & Endoscopy Volume 2, Issue 3, July 2024, Pages 107-111