title: [Test of refractory gastroesophageal reflux disease].
abstract: It should be considered that the causes of refractory gastroesophageal reflux disease (GERD) are multifactorial. Esophageal manometry study is useful when we make distinguish patients with esophageal motility disorders from those with refractory GERD. Endoscopic ultrasonography is also performed to observe the thickness of esophageal wall which represents the disturbance of esophageal motor function. Esophageal pH monitoring is useful to detect the acid clearance disturbance and phenomenon of nocturnal acid breakthrough. Both are occurred at night, and are recently considered to be responsible for refractory GERD. Catheter-free pH monitoring system, Bravo, makes it possible to measure esophageal pH under quite physiological conditions. Genotype of CYP2C19 is sometimes checked in patients with PPI resistance GERD. Intra-gastric pH with omeprazole and lansoprazole depends on patient's genotype of CYP2C19. Monitoring of 24-hour bilirubin, Bilitec, is also useful to detect duodeno-gastro-esophageal reflux.
authors.affiliation: Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Shimoyama
authors.forename: Shikou
authors.initials: S
authors.lastname: Kuribayashi
authors.forename: Masaki
authors.initials: M
authors.lastname: Maeda
authors.forename: Motoyasu
authors.initials: M
authors.lastname: Kusano
mesh_terms: D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics; D001646:Bile / Q000737:chemistry; D001663:Bilirubin / Q000032:analysis; D015415:Biomarkers / Q000032:analysis; D002940:Circadian Rhythm; D065731:Cytochrome P-450 CYP2C19; D003937:Diagnosis, Differential; D019160:Endosonography; D004791:Enzyme Inhibitors; D004945:Esophagoscopy; D004947:Esophagus / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D005764:Gastroesophageal Reflux / Q000175:diagnosis*; D005838:Genotype; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008365:Manometry; D006899:Mixed Function Oxygenases / Q000235:genetics; D008991:Monitoring, Physiologic; D009853:Omeprazole; D054328:Proton Pump Inhibitors
chemical_list: D015415:Biomarkers; D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors; D006899:Mixed Function Oxygenases; D001189:Aryl Hydrocarbon Hydroxylases; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D009853:Omeprazole; D001663:Bilirubin