What is nonacid reflux disease?
Proton pump inhibitors (PPIs) are the gold standard treatment for gastroesophageal reflux disease. In clinical practice, failure of PPIs occurs frequently, and may affect up to 30% of patients in a typical gastroenterology practice. Multichannel impedance monitoring combined with pH monitoring helps to detect nonacid reflux, and if symptoms correlate with these nonacid reflux episodes, nonacid reflux disease can be diagnosed. In contrast to PPIs, reflux inhibitors target transient lower esophageal sphincter relaxations, which are involved in the pathophysiology of reflux disease and may be the appropriate future treatment for nonacid reflux disease. The present article discusses the current understanding of nonacid reflux disease, its diagnosis and treatment.
University of Calgary Medical Clinic, Calgary, Alberta. mstorr@ucalgary.ca
Martin A
MA
Storr
D001418:Baclofen / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D049630:Esophageal Sphincter, Lower / Q000187:drug effects / Q000503:physiopathology*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D010721:Phosphinic Acids / Q000494:pharmacology / Q000627:therapeutic use; D011437:Propylamines / Q000494:pharmacology / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011963:Receptors, GABA-A / Q000187:drug effects
D010721:Phosphinic Acids; D011437:Propylamines; D054328:Proton Pump Inhibitors; D011963:Receptors, GABA-A; C545087:lesogaberan; D001418:Baclofen; C543531:arbaclofen placarbil
Gastroenterology. 2001 Jun;120(7):1599-606
11375942
Gastroenterology. 2000 Jan;118(1):7-13
10611148
Aliment Pharmacol Ther. 2007 Dec;26 Suppl 2:7-12
18081643
Aliment Pharmacol Ther. 2010 Jun;31(11):1208-17
20222915
Gut. 2005 Apr;54(4):449-54
15753524
Expert Opin Pharmacother. 2001 Jul;2(7):1099-108
11583061
Gut. 2004 Jul;53(7):1024-31
15194656
Aliment Pharmacol Ther. 2009 Nov 1;30(9):937-46
19650825
Aliment Pharmacol Ther. 2003 Jan;17(2):243-51
12534409
Am J Gastroenterol. 2010 Jun;105(6):1266-75
20040914
Am J Gastroenterol. 2001 Oct;96(10):2849-57
11695354
Aliment Pharmacol Ther. 2004 Apr 15;19(8):907-15
15080852
Gut. 2006 Oct;55(10):1398-402
16556669
Br J Surg. 2006 Dec;93(12):1483-7
17051602
Gut. 2003 Apr;52(4):464-70
12631652
Chest. 2006 Aug;130(2):386-91
16899836
Am J Gastroenterol. 1999 Feb;94(2):306-17
10022621