{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T20:57:11Z","timestamp":1783112231185,"version":"3.54.6"},"reference-count":16,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2022,5,3]],"date-time":"2022-05-03T00:00:00Z","timestamp":1651536000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Refractory reflux\u2010like symptoms have a substantial impact on patients and healthcare providers. The aim of the survey was to qualitatively assess the needs and attitudes of practicing clinicians around the management of refractory reflux symptoms and refractory gastroesophageal reflux disease (rGERD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An International Working Group for the Classification of Oesophagitis (IWGCO) steering committee invited clinicians to complete an online survey including 17 questions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key results<\/jats:title><jats:p>Of the 113 clinicians who completed the survey, 70% were GIs, 20% were primary care physicians, and 10% were other specialties. Functional heartburn was considered the most common reason for an incomplete response to proton pump inhibitor (PPI) therapy (82%), followed by stress\/anxiety (69%). More GIs identified esophageal hypersensitivity as a cause, while more non\u2010GIs identified esophageal dysmotility and non\u2010reflux\u2010related esophageal conditions. As the first step, most clinicians would order investigations (70\u201388%). Overall, 72% would add supplemental therapy for patients with partial response, but only 58% for those with non\u2010response. Antacid\/alginate was the most common choice overall, while non\u2010GIs were more likely to add a prokinetic than were GIs (47.8 vs. 24.1%). Approximately 40% of clinicians would switch PPIs in patients with partial response, but only 29% would do so in non\u2010responders. Preferences for long\u2010term therapy were highly variable. The most common initial investigation was upper endoscopy. Choice of esophageal manometry and pH monitoring was more variable, with no clear preference for whether pH monitoring should be conducted on, or off, PPI therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Inferences<\/jats:title><jats:p>The survey identified a number of challenges for clinicians, especially non\u2010GI physicians, treating patients with refractory reflux\u2010like symptoms or rGERD on a daily basis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.14387","type":"journal-article","created":{"date-parts":[[2022,5,3]],"date-time":"2022-05-03T12:34:50Z","timestamp":1651581290000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Knowledge gaps in the management of refractory reflux\u2010like symptoms: Healthcare provider survey"],"prefix":"10.1111","volume":"34","author":[{"given":"David","family":"Armstrong","sequence":"first","affiliation":[{"name":"Division of Gastroenterology &amp; Farncombe Family Digestive Health Research Institute McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amrit Pali","family":"Hungin","sequence":"additional","affiliation":[{"name":"Faculty of Medical Sciences Newcastle University  Newcastle upon Tyne UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8260-1250","authenticated-orcid":false,"given":"Peter J.","family":"Kahrilas","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4894-0523","authenticated-orcid":false,"given":"Daniel","family":"Sifrim","sequence":"additional","affiliation":[{"name":"Barts and The London School of Medicine and Dentistry Queen Mary, University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Sinclair","sequence":"additional","affiliation":[{"name":"INSINC Consulting Inc.  Guelph Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael F.","family":"Vaezi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prateek","family":"Sharma","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Veterans Affairs Medical Center University of Kansas School of Medicine  Kansas City Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,5,3]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(19)30408-X"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2019.12.014"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14075"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000001538"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2011.04774.x"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000000762"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2017.07.040"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2017-314722"},{"issue":"1","key":"e_1_2_9_10_1","doi-asserted-by":"crossref","first-page":"62","DOI":"10.33590\/emjgastroenterol\/10314735","article-title":"Refractory gastroesophageal reflux disease: pathophysiology, diagnosis, and management","volume":"8","author":"Nabi Z","year":"2019","journal-title":"EMJ Gastroenterol"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-1241.2008.01923.x"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2010.368"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.13567"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm20161"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1442-2050.2011.01227.x"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/jcag\/gwy009.226"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.16407"}],"container-title":["Neurogastroenterology &amp; Motility"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nmo.14387","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/nmo.14387","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nmo.14387","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,22]],"date-time":"2023-08-22T07:58:29Z","timestamp":1692691109000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/nmo.14387"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,3]]},"references-count":16,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2022,10]]}},"alternative-id":["10.1111\/nmo.14387"],"URL":"https:\/\/doi.org\/10.1111\/nmo.14387","archive":["Portico"],"relation":{},"ISSN":["1350-1925","1365-2982"],"issn-type":[{"value":"1350-1925","type":"print"},{"value":"1365-2982","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,3]]},"assertion":[{"value":"2022-02-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-04-11","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-05-03","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e14387"}}