Vonoprazan in Management of Refractory Gastroesophageal Reflux Disease: An Indian Expert Group Consensus Statements.

BACKGROUND

Approximately, 40% of gastroesophageal reflux disease (GERD) patients experience insufficient symptom relief from proton-pump inhibitors (PPI), resulting in PPI-refractory GERD (rGERD).

OBJECTIVE

To review the existing literature and develop an Indian expert group consensus statement on the place of vonoprazan in the management of rGERD.

MATERIALS AND

METHODS

A panel of 35 leading Indian gastroenterologists extensively reviewed the literature to develop consensus statements for the management of rGERD in Indian patients, with a focus on the newly available potassium-competitive acid blocker (P-CAB), vonoprazan. This process involved two structured meetings in which experts deliberated on literature reviews and draft statements, which were further rigorously discussed and modified. Consensus was achieved through a voting process employing a five-point Likert scale, with results meticulously documented. The final statements unanimously approved by all participants and subsequently developed into a comprehensive manuscript.

RESULTS

Based on the evidence, 14 statements were developed and confirmed by expert panelists for the assessment and management of rGERD. Among these 14 statements, 5 obtained Level A evidence, 4 received Level B, 4 were classified as Level C, and 1 as Level D. The consensus highlights the importance of symptom assessment, lifestyle modifications, and medication adherence, followed by a diagnostic procedure with upper gastrointestinal (GI) endoscopy. If needed, manometry or 24-hour pH impedance may be considered. Vonoprazan, a novel and reversible potassium-competitive acid blocker (P-CAB), has emerged as a potential alternative to proton pump inhibitors (PPIs), offering rapid, potent, and sustained acid suppression. Based on current evidence, a daily dose of 20 mg vonoprazan for 4-8 weeks is recommended as an initial treatment strategy for rGERD.

CONCLUSION

The consensus endorses the use of vonoprazan to improve patient outcomes and quality of life, highlighting its important place in therapy for controlling rGERD in Indian patients.