Refractory GERD: What is it?

被引：62

作者：

Fass R. ^{[1
]}

Gasiorowska A. ^{[1
]}

机构：

[1] University of Arizona, Southern Arizona VA Health Care System, Tucson, AZ 85723-0001

来源：

Current Gastroenterology Reports | 2008年 / 10卷 / 3期

关键词：

Lansoprazole; Erosive Esophagitis; Eosinophilic Esophagitis; Proton Pump Inhibitor Therapy; GERD Patient;

D O I：

10.1007/s11894-008-0052-5

中图分类号：

学科分类号：

摘要：

Refractory gastroesophageal reflux disease (GERD) is very common and may affect up to 40% of patients who use a proton pump inhibitor (PPI) once daily. Refractory GERD can present as incomplete or lack of response to PPI therapy. The disorder is clearly driven by patients, who present with a wide range of symptom severity and frequency while on PPI treatment. Poor compliance and improper timing of PPI consumption should always be excluded before further evaluation of this patient population. The putative mechanisms for refractory GERD include weakly acidic reflux, duodenogastroesophageal/bile reflux, visceral hypersensitivity, delayed gastric emptying, psychological comorbidity, and concomitant functional bowel disorders. Reduced PPI bioavailability, rapid PPI metabolism, PPI resistance, nocturnal reflux, and Helicobacter pylori infection status have very limited roles in refractory GERD. The contribution of eosinophilic esophagitis to refractory GERD is still unknown. Pill-induced esophagitis, Zollinger-Ellison syndrome, achalasia, and other disorders are rarely responsible for PPI failure and usually are not confused with GERD. © Springer Science+Business Media, LLC 2008.

引用

页码：252 / 257

页数：5

共 27 条

[1]

Fass R., Shapiro M., Dekel R., Sewell J., Systematic review: Proton-pump inhibitor failure in gastro-oesophageal reflux disease - Where next?, Aliment Pharmacol Ther, 22, pp. 79-94, (2005)

[2]

Targownik L.E., Metge C., Roos L., Leung S., The prevalence of and the clinical and demographic characteristics associated with high-intensity proton pump inhibitor use, Am J Gastroenterol, 102, pp. 942-950, (2007)

[3]

Crawley J.A., Schmitt C.M., How satisfied are chronic heartburn sufferers with their prescription medications? Rules of the Patient Unmet Needs Survey, J Clin Outcomes Manag, 7, pp. 29-34, (2000)

[4]

Dean B.B., Gano Jr. A.D., Knight K., Et al., Effectiveness of proton pump inhibitors in nonerosive reflux disease, Clin Gastroenterol Hepatol, 2, pp. 656-664, (2004)

[5]

Lind T., Havelund T., Carlsson R., Et al., Heartburn without oesophagitis: Efficacy of omeprazole therapy and features determining therapeutic response, Scand J Gastroenterol, 32, pp. 974-979, (1997)

[6]

Richter J.E., Kahrilas P.J., Johanson J., Et al., Efficacy and safety of esomeprazole compared to omeprazole in GERD patients with erosive esophagitis: A randomized controlled trial, Am J Gastroenterol, 96, pp. 656-665, (2001)

[7]

Johnson D.A., Lauritsen K., Junghard O., Levine D., Evaluation of symptoms is an unreliable predictor of relapse of erosive esophagitis in patients receiving maintenance PPI therapy, Gastroenterology, 124, 4 SUPPL., (2003)

[8]

Gunaratnam N.T., Jessup T.P., Inadomi J.M., Lascewski D.P., Sub-optimal proton pump inhibitor dosing is prevalent in patients with poorly controlled gastro-oesophageal reflux disease, Aliment Pharmacol Ther, 23, pp. 1473-1477, (2006)

[9]

Vela M., Camacho-Lobato L., Srinivasan R., Et al., Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux: Effect of omeprazole, Gastroenterology, 120, pp. 1599-1606, (2001)

[10]

Mainie I., Tutuian R., Shay S., Et al., Acid and non-acid reflux in patients with persistent symptoms despite acid suppressive therapy. A multicentre study using combined ambulatory impedance-pH monitoring, Gut, 55, pp. 1398-1402, (2006)

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