Acid peptic disorder compass: An Indian expert consensus on comprehensive management

Abstract

Overlapping pathophysiological mechanisms of gastroesophageal reflux disease, peptic ulcer disease, and functional dyspepsia often limit the symptom-based diagnosis precision. Additionally, the easy availability of over-the-counter proton pump inhibitors has increased the instances of self-diagnosis and self-treatment in the Indian population. Prolonged, unsupervised use of acid suppressants may reduce the treatment efficacy and increase the risk of adverse effects, such as infections and nutrient deficiencies. Therefore, a task force of 13 leading gastroenterologists under the Society for Clinical Gastroenterology reviewed the existing evidence to develop expert consensus statements for differentiating the overlapping symptoms of acid peptic disorders (APD) and guiding the rational use of acid-suppressive therapies. The available literature was searched and summarized in order to identify the relevant data. The pieces of evidence were discussed, validated, and revised in a face-to-face interaction of the task force members that led to a final set of 20 consensus statements. A comprehensive algorithm of the APD 360° compass was prepared for diagnosis and effective management of APDs based on the recommendations. This algorithm may guide physicians in India for timely diagnosis and appropriate medical interventions, thereby improving the patients’ quality of life.

Keywords: Acid peptic disorders; Consensus; Dyspepsia; Gastroesophageal reflux disease; Peptic ulcer; Potassium-competitive acid blockers; Proton pump inhibitors; India

Core Tip: Overlapping mechanisms in gastroesophageal reflux disease, peptic ulcer, and functional dyspepsia often hinder accurate symptom-based diagnosis. In India, easy access to over-the-counter proton pump inhibitors has fuelled self-diagnosis and prolonged unsupervised use, which reduces treatment efficacy and increases risks of infections and nutrient deficiencies. To address this, a task force of 13 gastroenterologists under the Society for Clinical Gastroenterology reviewed evidence and developed 20 expert consensus statements. Through literature review and discussion, they proposed the acid peptic disorders 360° compass algorithm for distinguishing symptoms and guiding rational acid-suppressive therapy. This algorithm aims to improve timely diagnosis, treatment, and the patient’s quality of life.