Expert Opinion on the Utilization of Proton Pump Inhibitors for the Treatment of Gastroesophageal Reflux Disease among Indian Patients

Abstract

Several studies have demonstrated that esomeprazole enhances the management of gastroesophageal reflux disease (GERD) patients by reducing the incidence of heartburn and epigastric pain, as well as relapse rates. But, there was a dearth of data regarding the preference of esomeprazole. So, this study was conducted to gather expert opinions on the routine use of proton pump inhibitors (PPIs) in clinical practice with a focus on the utilization of esomeprazole as a maintenance therapy for GERD in Indian settings. A cross-sectional, questionnaire based study was conducted to collect opinion among physicians involved in managing GERD symptoms across India between June 2022 and December 2022. The study enrolled 972 participants, and 63% of them noted the frequent occurrence of both erosive and non-erosive reflux disease in GERD patients. Approximately 47% of the respondents identified obesity as a significant GERD risk factor, with 32% attributing it to irregular and unhealthy eating habits. The majority of the clinicians preferred PPIs for the treatment of GERD (90%), particularly esomeprazole (87%). The typical duration of PPIs for GERD patients was reported to be 2-4 weeks by approximately 57% of the experts. Most respondents recommended a combination of PPIs and prokinetic drugs for GERD treatment. When dealing with PPI-resistant patients, 56% of physicians preferred maintaining the same PPI therapy twice daily, while 32% advised switching to another PPI. The majority of the respondents (71.81%) recommended making dietary and lifestyle adjustments for managing GERD, including consuming smaller, more frequent meals, refraining from lying down for at least two hours after eating and addressing excess weight around the midsection. It was noted that clinicians recommended PPIs, especially esomeprazole, as the primary approach for GERD management. Experts advise a regimen of twice-daily PPIs for patients who exhibit resistance to the treatment. They also underscore the importance of dietary and lifestyle adjustments in GERD management.