A recent study highlighted areas of agreement for invasive management approaches for gastroesophageal reflux disease (GERD). It also offered a stimulus for further interdisciplinary collaboration and studies to compare, develop new and potent management approaches and care pathways. This also included the role of impedance-pH testing in proton pump inhibitor (PPI) non-responders.

A prospective study aimed to evaluate expert opinion and consent on the management of distinct GERD profiles (heartburn and regurgitation) from the surgical and therapeutic endoscopy perspectives, utilizing a validated prospective process.

To investigate the suitability of antireflux interventions among foregut surgeons and therapeutic gastroenterologists, the RAND/University of California, Los Angeles Appropriateness Method over six months (from July 2018 to Jan 2019) was utilized. Individuals having primary atypical or extraesophageal symptoms were excluded from this analysis. 

Based on their symptom response to PPIs, the patient scenarios were grouped. Notably, the appropriateness of intervention was the primary outcome ascertained.

For all the complete and partial PPI responder scenarios, the antireflux surgery with magnetic sphincter augmentation (MSA) and laparoscopic fundoplication (LF) was graded as relevant. In complete and partial PPI responders without a hiatal hernia, the transoral incisionless fundoplication was found to be relevant.

For complete or partial responders, the radiofrequency energy was not found to be suitable. For PPI nonresponders, there was a paucity of consent between surgery and interventional gastroenterology cohorts on the suitability of LF and MSA therapy. 

When the findings from impedance-pH testing on PPI were available, the rankings for PPI nonresponders demonstrated similarity. Only when the impedance-pH study was negative, the LF and MSA were not ranked as relevant for PPI non-responders.