title: Management of heartburn not responding to proton pump inhibitors.
abstract: Patients with gastro-oesophageal reflux disease (GORD) who are not responding to proton pump inhibitors (PPIs) given once daily are very common. Various underlying mechanisms have been shown to contribute to the failure of PPI treatment. These include weakly acidic reflux, duodenogastro-oesophageal reflux, residual acid reflux and functional heartburn, as well as others. Diagnostic evaluation of patients with GORD who have failed PPI treatment may include an upper endoscopy, pH testing and oesophageal impedance with pH monitoring. Commonly, doubling the PPI dose or switching to another PPI will be pursued by the treating physician. Failure of such a therapeutic strategy may result in the addition of a transient lower oesophageal sphincter reducer or pain modulator. Anti-reflux surgery may be suitable for a subset of carefully studied patients.
authors.affiliation: The Neuroenteric Clinical Research Group, Southern Arizona VA Health Care System, Tucson, Arizona 85723-0001, USA. Ronnie.Fass@va.gov
authors.forename: R
authors.initials: R
authors.lastname: Fass
authors.forename: D
authors.initials: D
authors.lastname: Sifrim
mesh_terms: D001706:Biopsy; D004334:Drug Administration Schedule; D050782:Esophageal pH Monitoring; D004945:Esophagoscopy; D004947:Esophagus / Q000187:drug effects; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000188:drug therapy*; D006356:Heartburn / Q000628:therapy*; D006801:Humans; D010349:Patient Compliance; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D017211:Treatment Failure
chemical_list: D054328:Proton Pump Inhibitors