title: Refractory heartburn to proton pump inhibitors: epidemiology, etiology and management.
abstract: Patients with refractory heartburn to proton pump inhibitors (PPIs) represent a distinctive group which is difficult to manage. In a systematic review of the relative literature we found that approximately 20% of patients with erosive esophagitis and 15-25% of patients with normal endoscopy and abnormal 24-hour esophageal pH monitoring continue to report heartburn despite treatment with standard dose PPIs. Furthermore, approximately 30-40% of patients with normal endoscopy and 24-hour pH studies and 15-20% of patients with Barrett's esophagus have refractory heartburn to double dose PPIs. In such cases, compliance to therapy, duodeno-gastroesophageal reflux, gastro-esophageal motility disorders and eradication of Helicobacter pylori infection may contribute to symptoms. Based on the available evidence, we suggested an algorithm for the evaluation and management of these patients.
authors.affiliation: Department of Gastroenterology, Athens Naval Hospital, GR-15341 Athens, Greece. spisgon@otenet.gr
authors.forename: Spiros N
authors.initials: SN
authors.lastname: Sgouros
authors.forename: Apostolos
authors.initials: A
authors.lastname: Mantides
mesh_terms: D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004791:Enzyme Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D018755:GABA Agonists / Q000627:therapeutic use*; D005764:Gastroesophageal Reflux / Q000188:drug therapy*; D006356:Heartburn / Q000139:chemically induced / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D015994:Incidence; D009125:Muscle Relaxants, Central / Q000627:therapeutic use*; D054328:Proton Pump Inhibitors; D016896:Treatment Outcome
chemical_list: D004791:Enzyme Inhibitors; D018755:GABA Agonists; D009125:Muscle Relaxants, Central; D054328:Proton Pump Inhibitors