Evolving issues in the management of reflux disease?
OBJECTIVE
Gastroesophageal reflux disease (GERD) is a common chronic disorder often successfully treated, although there are several evolving issues in management. We reviewed the issues related to unmet needs over the past 12 months.


RESULTS
A substantial number of patients fail to respond adequately to once or even twice daily proton pump inhibitor (PPI). There is no standard definition of PPI failure in GERD; a universally accepted definition for treatment success is also not available. Differentiation between erosive esophagitis and nonerosive reflux disease can be made but requires endoscopy; but studies still confuse functional heartburn and nonerosive reflux disease, which impacts management. Acid reflux plays an important role in GERD pathogenesis and the precise role of acid requires more studies of differences between erosive esophagitis and nonerosive reflux disease symptom generation and the implication of nocturnal acidification. Several possible mechanisms may explain GERD refractory to PPIs.


CONCLUSIONS
Management of PPI nonresponders remains a challenge. Objective and precise evaluation of symptoms and treatment response requires study in high-quality trials. New therapeutic approaches are under investigation to answer unmet needs and improve erosive esophagitis healing rates and symptom control.
Yuan
Yuhong
Y
Department of Medicine, Division of Gastroenterology, McMaster University Health Science Centre, Hamilton, Canada.
Hunt
Richard H
RH
D000897:Anti-Ulcer Agents / Q000008:administration & dosage; D003692:Delayed-Action Preparations; D004351:Drug Resistance; D015507:Drugs, Investigational / Q000494:pharmacology; D050782:Esophageal pH Monitoring; D004942:Esophagitis, Peptic / Q000517:prevention & control*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D005745:Gastric Acidity Determination; D005753:Gastric Mucosa / Q000187:drug effects / Q000473:pathology; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000897:Anti-Ulcer Agents; D003692:Delayed-Action Preparations; D015507:Drugs, Investigational; D054328:Proton Pump Inhibitors