Challenges and Evolving Approaches in Refractory GERD, With Kristina Skarbinski, NP

Refractory gastroesophageal reflux disease (GERD) can be a complex and frustrating condition for both patients and clinicians, often persisting despite lifestyle changes, over-the-counter remedies, and prescription therapies.

GERD is a frequently encountered diagnosis in clinical practice, affecting an estimated 8-33% of the general population. The definition of refractory GERD varies in current literature, but it is generally regarded as persistent evidence of pathologic reflux while on antisecretory therapy.

Managing these cases requires careful evaluation, diligent use of available treatments, and consideration of alternative diagnoses or advanced interventions. As understanding of reflux and related conditions continues to evolve, the focus remains on tailoring care to each patient to achieve meaningful relief, as highlighted at the 2025 Gastroenterology & Hepatology Advanced Practice Providers (GHAPP) conference.

“When [patients] come in to see you, they're very frustrated because they've been told that maybe they're making it up… they've tried all the dietary changes, they've tried over the counter meds, they've tried prescription meds. Trying to help have them buy into what you're going to do… they're skeptical, and rightfully so,” Kristina Skarbinski, NP, a nurse practitioner in the Massachusetts General Hospital Gastroenterology Department, told HCPLive. “Patients want to know an answer and they want it now, and you want to be able to do that, but oftentimes they're going to have to get put through various tests, and that can be challenging, too. It's more money, time, etc.”

Acknowledging challenges faced in refractory GERD management, Skarbinski describes the ongoing debate around proton pump inhibitors (PPIs), which have been linked to risks of C. diff, fractures, kidney disease, and nutritional deficiencies.

She notes that while risks exist with any medication, PPIs are generally safe, well tolerated, and highly effective for many patients when used appropriately. She emphasizes the importance of patient education, counseling individuals not to remain indefinitely on ineffective therapies but instead to seek evaluation that could uncover a more accurate diagnosis and better treatment options.

Looking ahead, Skarbinski expresses enthusiasm for the esophagus as a focus of clinical care and research. She notes conferences and collaborative discussions push the field forward, generating new questions and inspiring advances in treatment. Ultimately, her key message was that patients with persistent reflux symptoms should not lose hope: with thorough evaluation, individualized testing, and thoughtful use of available therapies, clinicians can identify the underlying cause and help patients achieve meaningful relief.

References

1. Cleveland Clinic. Proton Pump Inhibitors. September 28, 2023. Accessed September 9, 2025. https://my.clevelandclinic.org/health/articles/proton-pump-inhibitors

2. Davis TA, Gyawali CP. Refractory Gastroesophageal Reflux Disease: Diagnosis and Management. J Neurogastroenterol Motil. https://doi.org/10.5056/jnm23145