First Indian Consensus on Managing Refractory Gastroesophageal Reflux Disease Recommends Vonoprazan

A recent expert group consensus has endorsed the use of vonoprazan for managing refractory gastroesophageal reflux disease (rGERD) in Indian patients, highlighting its role in improving patient outcomes and quality of life.

This is the first Indian consensus on rGERD, published in the March 2025 issue of the Journal of the Association of Physicians of India.

Refractory GERD (rGERD) is the persistence of GERD symptoms despite using proton pump inhibitors (PPIs) for at least eight weeks, with confirmed ongoing gastroesophageal reflux. About 40% of patients do not respond well to PPIs, leading to rGERD.

Vonoprazan, a potassium-competitive acid blocker (P-CAB), reversibly inhibits the proton pump, offering faster, more consistent, and stronger acid suppression than PPIs.

Studies conducted in various countries have demonstrated the effectiveness of vonoprazan in managing rGERD. Recognizing the lack of published data on the Indian population, a panel of 35 leading Indian gastroenterologists conducted a thorough review of existing literature. Fourteen consensus statements were formulated through two structured meetings to guide the management of rGERD in Indian patients, with focus on Vonoprazan.

Once all participants agreed upon the statements, they were graded based on the level of evidence (LOE). Subsequently, they were put to a vote using a five-point Likert scale to achieve levels of agreement. (LOA).

Some of the key points from the consensus include:

• Partial non-response to PPI therapy in GERD can increase costs and reduce quality of life and productivity.
• For suspected rGERD, reassess symptoms, lifestyle, and medication compliance before escalating treatment.
• Refractory GERD patients post-endoscopy may need further tests like manometry and 24-hour pH impedance.
• Therapeutic lifestyle changes help improve rGERD symptoms and overall health.
• P-CABs including Vonoprazan and PPIs have comparable efficacy for initial GERD treatment.
• P-CAB is recommended for intermittent or on-demand long-term management of rGERD.
• Vonoprazan may be an alternative for PPI rGERD based on its pharmacokinetic & pharmacodynamic profile.
• Vonoprazan surpasses PPIs in healing and maintaining severe disease (LA C/D).
• Vonoprazan 20 mg once daily for 4–8 weeks is recommended for initial rGERD treatment.

The expert panel recommended vonoprazan as a suitable treatment for managing rGERD, highlighting its efficacy in sustained acid suppression. This consensus provided essential clinical guidance to enhance treatment approaches and improve patient care outcomes.

Reference: Abraham P, Choudhuri G, Deshmukh S, et al. Vonoprazan in Management of Refractory Gastroesophageal Reflux Disease: An Indian Expert Group Consensus Statements. J Assoc Physicians India 2025;73(3):e29–e36