Refractory gastroesophageal reflux disease (GERD): A clinical, endoscopic, and histopathological perspective –a single centre cross-sectional study

This study investigated the association between clinical characteristics, endoscopic findings, and histopathological alterations in patients with refractory GERD in India. Key findings: • Higher prevalence of ERD compared to NERD: 67% of patients had ERD, significantly higher than the 8.8% reported in the broader GERD population. • Increased frequency of hiatus hernia: 48% of patients had a hiatus hernia, with higher prevalence in ERD cases (53.7%) compared to NERD (18%). • Basal cell hyperplasia was the most common histopathological finding: 54% of patients showed this alteration, indicative of tissue damage. • No evidence of eosinophilic esophagitis: This contrasts with the 3.2% prevalence reported in previous studies. • First reported data on Barrett's esophagus in Indian GERD patients: The study identified a 3% prevalence rate. Implications: • Endoscopic examination is crucial for identifying erosive complications in refractory GERD patients. • Hiatus hernia is associated with more severe esophageal mucosal damage. • Further research is needed to understand the absence of eosinophilic esophagitis and the prevalence of Barrett's esophagus in India. • Understanding the relationship between clinical, endoscopic, and histopathological findings can lead to improved diagnosis, management, and patient care for refractory GERD. Future directions: • Conduct larger studies to confirm the findings and further investigate the prevalence of Barrett's esophagus and eosinophilic esophagitis in India. • Evaluate the effectiveness of different treatment strategies for refractory GERD based on specific histopathological features. • Investigate the influence of lifestyle factors and co-morbidities on the quality of life in patients with refractory GERD. Overall, this study provides valuable insights into the characteristics of refractory GERD in India and highlights the need for further research to improve diagnosis, management, and quality of life for patients with this condition. Limitation of our Study . Need for further research with multicenter, larger sample sizes, longitudinal designs, and more comprehensive data collection to confirm the findings of this study and gain a deeper understanding of refractory GERD in the Indian context.