Expert consensus for the management of gastroesophageal reflux disease in pregnancy: collaborative insights from experts in India

Abstract

Background: Gastroesophageal reflux disease (GERD) is common during pregnancy. In India, its management varies and is often based on Western guidelines, which may not reflect local dietary patterns, drug availability, or diagnostic constraints. To address this gap, an expert panel of Indian gastroenterologists and gynaecologists aimed to develop consensus recommendations tailored for Indian practice. Methods: Modified Delphi consensus method was followed. Steering committee with three gastroenterologists was formed. This committee reviewed available literature and identified 65 relevant articles, based on which 9 pilot consensus statements were formed. An expert panel comprising 9 gastroenterologists and 6 gynaecologists located pan-India was formed. Pre-reads were circulated a month in advance, and 15 experts discussed evidence and pilot statements during the consensus meeting. Based on the discussion, modified statements were shared with the experts through a Google form for voting using a 5-point Likert scale. Consensus was defined as ≥80% agreement. Results were analysed by the steering committee, followed by a virtual meeting to finalise statements. The manuscript was drafted and circulated for final approval. Results: Six consensus statements were finalised, with 100% agreement. (1a) Symptoms of gastroesophageal reflux are common during pregnancy. (1b) Gastroesophageal reflux is associated with poor health-related quality of life in pregnancy. (2) Diagnosis of gastroesophageal reflux during pregnancy should be based on symptoms. (3) Endoscopy must be postponed to the post-partum period, except in the presence of alarm symptoms. (4) Lifestyle changes are recommended as the first step in management. (5) Alginates/antacids should be preferred as the first-line pharmacological treatment after lifestyle changes. (6) Histamine-2 receptor antagonists or proton pump inhibitors are effective and may be used if symptoms are not controlled by alginates/antacids alone. Conclusion: These consensus statements provide practical guidance for diagnosing and managing GERD in pregnancy, emphasising symptom-based diagnosis, lifestyle interventions, and judicious pharmacological therapy.