Expert consensus for the management of gastroesophageal reflux disease in pregnancy: collaborative insights from experts in India
Bibliographic record
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.144 | 0.185 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.005 | 0.003 |
| Science and technology studies | 0.005 | 0.004 |
| Scholarly communication | 0.007 | 0.004 |
| Open science | 0.004 | 0.013 |
| Research integrity | 0.005 | 0.007 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".