Gastroenterology & Endoscopy (Jul 2024)
Refractory gastroesophageal reflux disease (GERD): A clinical, endoscopic, and histopathological perspective –a single centre cross-sectional study
Abstract
Background: Gastroesophageal reflux disease (GERD) manifests as the regurgitation of stomach contents into the esophagus, causing symptoms and potential complications. Proton Pump Inhibitors (PPIs) stand as the primary treatment, preferred for their efficacy. However, cases where patients exhibit no response or improvement following an 8-week regimen of PPIs at the recommended dosage are termed refractory GERD. In India, GERD poses a considerable strain on healthcare resources, impacting the quality of life for affected individuals. Yet, the precise prevalence and distinct manifestations of GERD in the general population remain unclear. Methods: A descriptive observational cross-sectional study was performed on patients attending the Department of Medical Gastroenterology at Meenakshi Medical College Hospital and Research Institute in Kanchipuram, Tamil Nadu, India. The study involved the examination, evaluation, and statistical correlation of the clinical symptoms, suspected risk factors, as well as histopathological and endoscopic findings in the patients. Results: Among 100 patients (average age: 39.03 ± 8.90 years, female-to-male ratio 1.7:1), regurgitation was the predominant symptom, followed by heartburn, with symptoms lasting 8 to 12 months, and a significant majority (69%) experiencing moderate to severe symptoms. Notably, regurgitation correlated significantly with waist circumference and Hill Grade (p<0.05). On endoscopy, 67% were diagnosed with erosive esophagitis (ERD), and 33% with non-erosive esophagitis (NERD), findings also significantly associated (p<0.05) with factors like low socio-economic status, alcohol consumption, and histological changes. Histological analysis showed that 56% of patients displayed signs of inflammation, with elongation of the papilla being the most prevalent. These findings significantly correlated (p<0.05) with factors like waist circumference and tobacco usage. Additionally, there was statistical significance (p < 0.05) in quality of life scores when patients received an extra 8 weeks of PPI alongside lifestyle changes and dietary modifications. Conclusions: In our study, we observed an added benefit of performing histology in NERD patients who showed inflammatory changes after 8 weeks of PPI treatment. This approach was employed due to the lack of guidelines for this particular patient group. Furthermore, our study revealed that incorporating lifestyle interventions such as engaging in elevating the head end while sleeping and abstaining from alcohol and smoking provided additional benefits in achieving optimal treatment response.
