title: Therapeutic options for refractory gastroesophageal reflux disease.
abstract: Refractory gastroesophageal reflux disease may affect up to one-third of the patients that consume proton pump inhibitor (PPI) once daily. Treatment in clinical practice has been primarily focused on doubling the PPI dose, despite lack of evidence of its value. In patients who failed PPI twice daily, medical treatment has been primarily focused on reducing transient lower esophageal sphincter relaxation rate or attenuating esophageal pain perception using visceral analgesics. In patients with evidence of reflux as the direct trigger of their symptoms, endoscopic treatment or antireflux surgery may be helpful in remitting symptoms. The role of psychological interventions, as well as non-traditional therapeutic strategies remains to be further elucidated.
authors.affiliation: The Neuroenteric Clinical Research Group, Southern Arizona VA Health Care System, University of Arizona, Tucson, Arizona 85723-0001, USA. ronnie.fass@va.gov
authors.forename: Ronnie
authors.initials: R
authors.lastname: Fass
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D000529:Complementary Therapies; D013505:Digestive System Surgical Procedures; D004351:Drug Resistance; D016099:Endoscopy, Gastrointestinal; D049630:Esophageal Sphincter, Lower / Q000187:drug effects / Q000503:physiopathology / Q000601:surgery; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D009465:Neuromuscular Agents / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011613:Psychotherapy; D040242:Risk Reduction Behavior; D017211:Treatment Failure
chemical_list: D000700:Analgesics; D005765:Gastrointestinal Agents; D006635:Histamine H2 Antagonists; D009465:Neuromuscular Agents; D054328:Proton Pump Inhibitors