title: Proton pump inhibitor resistance, the real challenge in gastro-esophageal reflux disease.
abstract: Gastro-esophageal reflux disease (GERD) is one of the most prevalent chronic diseases. Although proton pump inhibitors (PPIs) represent the mainstay of treatment both for healing erosive esophagitis and for symptom relief, several studies have shown that up to 40% of GERD patients reported either partial or complete lack of response of their symptoms to a standard PPI dose once daily. Several mechanisms have been proposed as involved in PPIs resistance, including ineffective control of gastric acid secretion, esophageal hypersensitivity, ultrastructural and functional changes in the esophageal epithelium. The diagnostic evaluation of a refractory GERD patients should include an accurate clinical evaluation, upper endoscopy, esophageal manometry and ambulatory pH-impedance monitoring, which allows to discriminate non-erosive reflux disease patients from those presenting esophageal hypersensitivity or functional heartburn. Treatment has been primarily based on doubling the PPI dose or switching to another PPI. Patients with proven disease, not responding to PPI twice daily, are eligible for anti-reflux surgery.
authors.affiliation: Michele Cicala, Sara Emerenziani, Michele Pier Luca Guarino, Mentore Ribolsi, Unit of Digestive Disease, Campus Bio Medico University of Rome, 00128 Rome, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Cicala
authors.forename: Sara
authors.initials: S
authors.lastname: Emerenziani
authors.forename: Michele Pier Luca
authors.initials: MP
authors.lastname: Guarino
authors.forename: Mentore
authors.initials: M
authors.lastname: Ribolsi
mesh_terms: D004305:Dose-Response Relationship, Drug; D004351:Drug Resistance; D057915:Drug Substitution; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D018579:Patient Selection; D011237:Predictive Value of Tests; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D017211:Treatment Failure
chemical_list: D054328:Proton Pump Inhibitors
keywords: Ambulatory pH-impedance monitoring; Esophageal hypersensitivity; Gastro-esophageal reflux disease; Gastro-esophageal reflux disease treatment; Proton pump inhibitor