[Pathogenesis and treatment of refractory gastroesophageal reflux disease in Japanese patients].
Prevalence of refractory gastroesophageal reflux disease (GERD) defined as a patient who have persistent GERD symptoms during treatment with proton pump inhibitor (PPI) is rare in Japanese patinets. Pathogenesis of refractory GERD is associated with several factors including dysfunction of esophageal motility, presence of severe hiatal hernia, complication such as stricture and short esophagus, extensive metabolizer of CYP2C19 genotype, nocturnal gastric acid breakthrough, absence of H. pylori infection, or bile reflux. Examination by 24 hr pH monitoring is necessary to assess refractory GERD and if acid suppression is insufficient, treatment with double doses of PPIs or combination of PPI and H2 blocker is effective. However, most cases of refractory GERD are required surgical treatment. Endoscopic therapy might be useful for refractory GERD in future.
Fujiwara
Yasuhiro
Y
Department of Gastroenterology, Osaka City University, Graduate School of Medicine.
Higuchi
Kazuhide
K
Yamamori
Kazuki
K
Watanabe
Yoko
Y
Shiba
Masatsugu
M
Watanabe
Toshio
T
Tominaga
Kazunari
K
Oshitani
Nobuhide
N
Matsumoto
Takayuki
T
Arakawa
Tetsuo
T
D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics; D065731:Cytochrome P-450 CYP2C19; D004791:Enzyme Inhibitors / Q000008:administration & dosage; D015154:Esophageal Motility Disorders / Q000150:complications; D004940:Esophageal Stenosis / Q000150:complications; D004945:Esophagoscopy; D004947:Esophagus / Q000503:physiopathology; D005744:Gastric Acid / Q000378:metabolism; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D005838:Genotype; D016481:Helicobacter Infections / Q000150:complications; D016480:Helicobacter pylori; D006551:Hernia, Hiatal / Q000150:complications; D006635:Histamine H2 Antagonists / Q000008:administration & dosage; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007564:Japan; D008019:Life Style; D006899:Mixed Function Oxygenases / Q000235:genetics; D008991:Monitoring, Physiologic; D054328:Proton Pump Inhibitors
D004791:Enzyme Inhibitors; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D006899:Mixed Function Oxygenases; D001189:Aryl Hydrocarbon Hydroxylases; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19