Diagnosis and management of patients with reflux symptoms refractory to proton pump inhibitors.
Approximately a third of patients with suspected gastro-oesophageal reflux disease are resistant or partial responders to proton pump inhibitors (PPIs). Many of these patients do not have gastro-oesophageal reflux disease, but suffer from functional heartburn or dyspepsia. The potential mechanisms underlying failure of PPI treatment in patients with reflux-related symptoms include persistence of isolated or mixed acid, weakly acidic, bile or gas reflux, impaired oesophageal mucosal integrity, chemical or mechanical hypersensitivity to refluxates and psychological comorbidity. After thorough clinical evaluation and failure of empirical changes in PPI dose regime, diagnostic investigations include endoscopy and reflux monitoring with pH or pH-impedance monitoring. If symptoms are clearly related to persistent reflux, baclofen, antireflux surgery or pain modulators can be considered. If not, pain modulators are the only currently available therapy.
Wingate Institute of Neurogastroenterology, Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK. d.sifrim@qmul.ac.uk
Daniel
D
Sifrim
Frank
F
Zerbib
D004351:Drug Resistance / Q000502:physiology; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*
D054328:Proton Pump Inhibitors