Gastroesophageal reflux disease (GERD) encompasses a spectrum of phenotypes that require an individualized approach to diagnosis and management. In this expert podcast, Rena Yadlapati, MD, MS, Director of the GI motility lab and Program Director of the advanced fellowship in esophageal diseases at UCSD, reviews practical strategies for distinguishing erosive from nonerosive and unproven GERD, optimizing lifestyle and pharmacologic therapy, and addressing patients with an inadequate response to proton pump inhibitors (PPIs). The discussion highlights the evolving role of potent acid suppression, including potassium-competitive acid blockers (P-CABs) such as vonoprazan, and examines where these newer therapies may fit within stepwise, phenotype-driven treatment algorithms. The intended audience for this podcast (with video where available) includes gastroenterologists and the APPs who support them, but also other internists and PCPs who often co-manage patients with GERD.

Learning Objectives

Upon completion of this activity, participants should be able to:

• Distinguish the mechanism of action and key pharmacokinetic properties of a PCAB from PPIs, and identify the GERD patient phenotypes most likely to derive differential benefit from potassium-competitive acid blockade
• Apply Phase 3 clinical trial evidence from and supporting comparative data to integrate PCAB therapy appropriately into a stepwise treatment algorithm for erosive and non-erosive GERD, including decision points for first-line use, PPI transition, and maintenance
• Effectively communicate treatment rationale and co-management expectations to PCPs and APPs when initiating PCAB therapy, in order to prevent inadvertent therapeutic substitution and support continuity of care