scholarly journals Inconsistency in the Diagnosis of Functional Heartburn: Usefulness of Prolonged Wireless pH Monitoring in Patients With Proton Pump Inhibitor Refractory Gastroesophageal Reflux Disease

2015 ◽  
Vol 21 (2) ◽  
pp. 265-272 ◽  
Author(s):  
Roberto Penagini ◽  
Rami Sweis ◽  
Aurelio Mauro ◽  
Gerson Domingues ◽  
Andres Vales ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Proton Pump Inhibitor ◽  
Gastroesophageal Reflux ◽  
Proton Pump ◽  
Reflux Disease ◽  
Ph Monitoring ◽  
Functional Heartburn

scholarly journals Current management of proton pump inhibitor-refractory gastroesophageal reflux disease

2020 ◽  
Vol 5 (2) ◽  
pp. 93-100
Author(s):  
V. V. Tsukanov ◽  
A. V. Vasyutin ◽  
Yu. L. Tonkikh
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Proton Pump Inhibitor ◽  
Gastroesophageal Reflux ◽  
Proton Pump ◽  
Reflux Disease ◽  
Ph Monitoring ◽  
Developed Countries ◽  
Acid Exposure ◽  
Functional Heartburn ◽  
Nonerosive Reflux Disease

Here we review current concepts in diagnosis and treatment of proton pump inhibitor (PPI)-refractory gastroesophageal reflux disease (PPIGERD) which includes an insufficient response to daily PPI 8-week therapy in combination with pathological gastroesophageal reflux. Patients with PPI-GERD frequently suffer from non-acidic and asymptomatic gastroesophageal reflux. In developed countries, PPI-GERD accounts for 30-40% of all patients receiving PPIs. Diagnosis of PPIGERD is performed by means of clinical anamnesis, esophagogastroscopy and impedance-pH monitoring. PPI-GERD needs to be differentiated with functional heartburn, reflux hypersensitivity and nonerosive reflux disease. Functional heartburn is characterised by reference time with a esophageal pH < 4 and the absence of a link between reflux episodes and GERD symptoms. Reflux hypersensitivity is diagnosed with normal esophageal acid exposure and association of reflux episodes with symptoms of GERD. Nonerosive reflux disease can be diagnosed solely by evaluating pathological acid exposure (pH < 4 for > 6% of the time). Treatment of PPI-GERD includes diet and lifestyle modification to reduce weight in obese patients, optimization of PPI use, and administration of alginate, prokinetics, baclofen and other drugs. Surgical treatment is also widely used and provide good results.

scholarly journals ARE THE PERSISTENT SYMPTOMS TO PROTON PUMP INHIBITOR THERAPY DUE TO REFRACTORY GASTROESOPHAGEAL REFLUX DISEASE OR TO OTHER DISORDERS?

2018 ◽  
Vol 55 (suppl 1) ◽  
pp. 85-91 ◽  
Author(s):  
Rimon Sobhi AZZAM
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Proton Pump Inhibitor ◽  
Gastroesophageal Reflux ◽  
Proton Pump ◽  
Reflux Disease ◽  
Clinical Condition ◽  
Ph Monitoring ◽  
Acid Reflux ◽  
Pathophysiological Mechanism ◽  
Refractory Gerd

ABSTRACT BACKGROUND: Gastroesophageal reflux disease (GERD) is a clinical condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Transient lower esophageal sphincter relaxation is the main pathophysiological mechanism of GERD. Symptoms and complications can be related to the reflux of gastric contents into the esophagus, oral cavity, larynx and/or the lung. Symptoms and other possible manifestations of GERD are heartburn, regurgitation, dysphagia, non-cardiac chest pain, chronic cough, chronic laryngitis, asthma and dental erosions. The proton pump inhibitor (PPI) is the first-choice drug and the most commonly medication used for the treatment of GERD. The most widespread definition of Refractory GERD is the clinical condition that presents symptoms with partial or absent response to twice-daily PPI therapy. Persistence of symptoms occurs in 25% to 42% of patients who use PPI once-daily and in 10% to 20% who use PPI twice-daily. OBJECTIVE: The objective is to describe a review of the current literature, highlighting the causes, diagnostic aspects and therapeutic approach of the cases with suspected reflux symptoms and unresponsive to PPI. CONCLUSION: Initially, the management of PPI refractoriness consists in correcting low adherence to PPI therapy, adjusting the PPI dosage and emphasizing the recommendations on lifestyle modification change, avoiding food and activities that trigger symptoms. PPI decreases the number of episodes of acid reflux; however, the number of “non-acid” reflux increases and the patient continues to have reflux despite PPI. In this way, it is possible to greatly reduce greatly the occurrence of symptoms, especially those dependent on the acidity of the refluxed material. Response to PPI therapy can be evaluated through clinical, endoscopic, and reflux monitoring parameters. In the persistence of the symptoms and/or complications, other causes of Refractory GERD should be suspected. Then, diagnostic investigation must be initiated, which is supported by clinical parameters and complementary exams such as upper digestive endoscopy, esophageal manometry and ambulatory reflux monitoring (esophageal pH monitoring or esophageal impedance-pH monitoring). Causes of refractoriness to PPI therapy may be due to the true Refractory GERD, or even to other non-reflux diseases, which can generate symptoms similar to GERD. There are several causes contributing to PPI refractoriness, such as inappropriate use of the drug (lack of patient adherence to PPI therapy, inadequate dosage of PPI), residual acid reflux due to inadequate acid suppression, nocturnal acid escape, “non-acid” reflux, rapid metabolism of PPI, slow gastric emptying, and misdiagnosis of GERD. This is a common cause of failure of the clinical treatment and, in this case, the problem is not the treatment but the diagnosis. Causes of misdiagnosis of GERD are functional heartburn, achalasia, megaesophagus, eosinophilic esophagitis, other types of esophagitis, and other causes. The diagnosis and treatment are specific to each of these causes of refractoriness to clinical therapy with PPI.

Potential reasons for proton pump inhibitor failure in the treatment of gastroesophageal reflux disease

2008 ◽  
Vol 149 (40) ◽  
pp. 1881-1888 ◽  
Author(s):  
Márk Juhász ◽  
Zsolt Tulassay
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Proton Pump Inhibitor ◽  
Gastroesophageal Reflux ◽  
Proton Pump ◽  
Reflux Disease

A protonpumpagátlók (protonpumpa-inhibitorok, PPI) bevezetése új fejezetet nyitott a gastrooesophagealis refluxbetegség (gastroesophageal reflux disease, GERD) kezelésében. A betegek kisebb, de nem jelentéktelen hányadában azonban a PPI sem hatékony. Ilyen esetekben az első kérdés mindig az, hogy a tünetek valóban GERD-nek tulajdoníthatók-e, vagy egyéb betegség után kell kutatnunk. Ha a GERD a legvalószínűbb lehetőség, akkor a további vizsgálatok és a több támadáspontú kezelés előtt fel kell térképeznünk a beteg együttműködését (compliance). Ha az eredménytelen PPI-kezelés hátterében nem helytelenül kezelt GERD áll, akkor számos egyéb kórkép lehetőségét is fel kell vetnünk. Összefoglaló közleményünkben az elkülönítő diagnosztikai kérdésekről adunk áttekintést.

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