Management of gastro-oesophageal reflux disease symptoms that do not respond to proton pump inhibitors

被引:10
作者
Woodland, Philip [1 ]
Sifrim, Daniel [1 ]
机构
[1] Queen Mary Univ London, Barts & London Sch Med & Dent, London, England
关键词
fundoplication; impedance; proton pump inhibitor; refractory GERD; ESOPHAGEAL PH-IMPEDANCE; EOSINOPHILIC ESOPHAGITIS; ACID REFLUX; DUODENOGASTROESOPHAGEAL REFLUX; FUNCTIONAL HEARTBURN; PPI THERAPY; DIAGNOSIS; TRIAL; GERD; FUNDOPLICATION;
D O I
10.1097/MOG.0b013e328360433c
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Purpose of reviewTreatment-refractory gastro-oesophageal reflux disease (GERD) remains a significant problem in the gastroenterology clinic. In recent years, several studies have investigated the assessment and treatment of refractory GERD. Recent findingsPatients presenting with refractory GERD' in fact represent a quite heterogeneous group consisting of those with ongoing reflux-related symptoms and those with reflux-unrelated problems such as functional heartburn, dyspepsia or even eosinophilic oesophagitis. The greatest symptom indicators of persistent true reflux are retrosternal burning and acid taste in the mouth alone. Combined pH-impedance studies allow detection of reflux regardless of pH, and weakly acidic reflux has been suggested as a mechanism of residual symptoms in some patients. The use of reflux-symptom association calculations may help to determine the symptom causation, but refinement and outcome studies are needed. New treatments of refractory GERD have been disappointing. Surgery remains an option in very carefully selected patients, but again better outcome studies are required. SummaryCareful history and investigation is required in the assessment of the proton pump inhibitor (PPI)-refractory patient. Care to exclude alternative diagnoses is needed, and to phenotype those with reflux-related symptoms. Optimization of PPI therapy may help, as may surgery in selected patients.
引用
收藏
页码:431 / 436
页数:6
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