title: [Pathophysiology and Treatment of PPI-resistant NERD].
abstract: Only about 50% of patients with non-erosive reflux disease (NERD) respond to standard doses of proton pump inhibitors (PPI). Various mechanisms have been proposed to explain PPI failure. Visceral hypersensitivity plays a basic role in the pathogenesis of NERD. Causes of persistent symptoms have been determined in 60% of patients with PPI-resistant NERD, including non-acid reflux (35-40%), acid reflux (10-15%), esophageal motility disorders (10%) and eosinophilic esophagitis (2%). Treatment based on these causes has been shown to improve patient symptoms. The causes of symptoms in the remaining 40% of patients, however, remain unknown, and these patients are often diagnosed with functional heartburn. Studies are needed to clarify the pathophysiologic mechanisms underlying functional heartburn in these patients.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Kawami
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Iwakiri
authors.forename: Choitsu
authors.initials: C
authors.lastname: Sakamoto
mesh_terms: D057765:Eosinophilic Esophagitis / Q000188:drug therapy; D015154:Esophageal Motility Disorders / Q000503:physiopathology; D050782:Esophageal pH Monitoring; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000503:physiopathology*; D006801:Humans; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*
chemical_list: D054328:Proton Pump Inhibitors