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Daily Medical Update
Gastroesophageal Reflux Disease
Tuesday, May 26, 2026
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🔬 Practice-Changing Findings
Evidence from RCTs and meta-analyses published in the
last 12 months.
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Journal of clinical gastroenterology (2025) - Meta-Analysis
Key Findings
- Baclofen add-on therapy improved GERD-Q symptom scores versus PPI therapy alone (SMD -0.78, 95% CI -1.06 to -0.51; I2=0%).
- Adjunctive baclofen reduced nonacid reflux episodes (SMD -0.93, 95% CI -1.49 to -0.37) and improved DeMeester scores (SMD -0.82, 95% CI -1.61 to -0.04).
- Acid reflux episodes were not significantly reduced versus control (SMD -0.12, 95% CI -0.49 to 0.19).
📋 Practice Implication: Baclofen is a reasonable short-term adjunct for refractory GERD when nonacid reflux is suspected, but it should not be framed as a substitute for acid suppression.
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Digestive diseases and sciences (2025) - Network Meta-Analysis
Key Findings
- Vonoprazan achieved higher week-2 endoscopic healing than lansoprazole overall (RR 1.09, 95% CI 1.04-1.13; p<0.0001).
- In severe erosive esophagitis (LA C/D), vonoprazan improved healing at week 2 (RR 1.26, 95% CI 1.15-1.38) and week 8 (RR 1.13, 95% CI 1.03-1.24).
- Vonoprazan 20 mg reduced maintenance-phase recurrence versus lansoprazole 15 mg (RR 0.41, 95% CI 0.17-0.85) with no significant increase in TEAEs.
📋 Practice Implication: For erosive esophagitis, especially LA grade C or D disease, vonoprazan is a strong option when faster healing or more durable remission is the priority.
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Surgical endoscopy (2025) - Meta-Analysis
Key Findings
- ARMA significantly reduced median acid exposure time after treatment (SMD -20.74, 95% CI -25.51 to -15.97; p<0.0001).
- ARMS significantly improved DeMeester scores (SMD -2.79, 95% CI -4.33 to -1.26; p<0.0001).
- Clinical success reached 78% for ARMS and 87% for ARMA.
📋 Practice Implication: In PPI-refractory GERD, ARMS or ARMA can be considered as less invasive escalation pathways before committing selected patients to formal antireflux surgery.
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Surgical endoscopy (2025) - Meta-Analysis
Key Findings
- Across 9516 patients, antireflux procedures produced statistically significant improvement in acid exposure time, DeMeester score, and relief scores.
- Compared with Nissen fundoplication, TIF showed less improvement in acid exposure time (MD -4.06, 95% CI -8.03 to -0.09; p=.045) and DeMeester score (MD -20.60, 95% CI -38.33 to -2.88; p=.023).
- MSA and Toupet fundoplication produced better symptom relief scores than Nissen (SMD 0.28, 95% CI 0.01-0.56 and SMD 0.17, 95% CI 0.01-0.32, respectively).
📋 Practice Implication: Procedure selection should match the dominant treatment goal: Nissen for stronger acid control, versus Toupet or MSA when postoperative symptom relief profile is more important.
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Digestive and liver disease (2025) - Meta-Analysis
Key Findings
- In endoscopy-negative reflux disease, PCABs increased heartburn resolution versus placebo (RR 1.43, 95% CI 1.22-1.68).
- PCABs reduced mean heartburn severity at 4 weeks (SMD 0.19, 95% CI -0.35 to -0.02).
- Treatment-emergent adverse events were comparable to placebo (OR 1.06, 95% CI 0.82-1.37).
📋 Practice Implication: For symptomatic ENRD, PCABs appear to offer a clinically useful pharmacologic option when conventional PPI response has been unsatisfactory or inconsistent.
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Summary
Recent GERD evidence emphasizes stronger acid suppression with potassium-competitive acid blockers, incremental benefit from baclofen in refractory disease, and meaningful gains from endoscopic or surgical antireflux interventions. Across erosive and endoscopy-negative phenotypes, the most actionable signals were higher healing or heartburn-resolution rates without major safety penalties, while procedure choice still requires balancing symptom control against dysphagia, gas-related effects, and long-term durability.
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