TY - JOUR
T1 - Management of the patient with incomplete response to PPI therapy
AU - Kahrilas, Peter J.
AU - Boeckxstaens, Guy
AU - Smout, Andre J.P.M.
N1 - Funding Information:
Dr Kahrilas was supported by grant R01 DC00646 from the United States Public Health Service .
Funding Information:
P.J. K serves as a paid consultant for AstraZeneca, Ironwood Pharmaceuticals, Reckitt Benckiser, Glaxo Smith Kline, and Torax. A.J.P.M.S. serves as a paid consultant for Reckitt Benckiser and has received financial support for educational meetings from MMS, Given Imaging and Shire Movetis . G.B. is supported by grants from the Research Foundation – Flanders (FWO) (Odysseus program, G.0905.07) and the agency for Innovation by Science and Technology (IWT), Belgium and has received grant support from Reckitt Benckiser.
PY - 2013
Y1 - 2013
N2 - Proton pump inhibitors (PPIs) remove most of the acid from the gastroesophageal refluxate. However, PPIs do not eliminate reflux and the response of specific GERD symptoms to PPI therapy depends on the degree to which acid drives those symptoms. PPIs are progressively less effective for heartburn, regurgitation, chest pain and extra-oesophageal symptoms. Hence, with an incomplete PPI response, obtaining an accurate history, detailing which symptoms are 'refractory' and exactly what evidence exists linking these symptoms to GERD is paramount. Reflux can continue to cause symptoms despite PPI therapy because of persistent acid reflux or weakly acidic reflux. Given these possibilities, diagnostic testing (pH or pH-impedance monitoring) becomes essential. Antireflux surgery is an alternative in patients if a clear relationship is established between persistent symptoms, particularly regurgitation, and reflux. Treating visceral hypersensitivity may also benefit the subset of GERD patients whose symptoms are driven by this mechanism.
AB - Proton pump inhibitors (PPIs) remove most of the acid from the gastroesophageal refluxate. However, PPIs do not eliminate reflux and the response of specific GERD symptoms to PPI therapy depends on the degree to which acid drives those symptoms. PPIs are progressively less effective for heartburn, regurgitation, chest pain and extra-oesophageal symptoms. Hence, with an incomplete PPI response, obtaining an accurate history, detailing which symptoms are 'refractory' and exactly what evidence exists linking these symptoms to GERD is paramount. Reflux can continue to cause symptoms despite PPI therapy because of persistent acid reflux or weakly acidic reflux. Given these possibilities, diagnostic testing (pH or pH-impedance monitoring) becomes essential. Antireflux surgery is an alternative in patients if a clear relationship is established between persistent symptoms, particularly regurgitation, and reflux. Treating visceral hypersensitivity may also benefit the subset of GERD patients whose symptoms are driven by this mechanism.
KW - Ambulatory oesophageal
KW - Ambulatory oesophageal pH-impedance monitoring
KW - Gastroesophageal reflux disease
KW - Oesophagus
KW - Proton pump inhibitors
KW - Visceral hypersensitivity
KW - pH monitoring
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U2 - 10.1016/j.bpg.2013.06.005
DO - 10.1016/j.bpg.2013.06.005
M3 - Review article
C2 - 23998978
AN - SCOPUS:85027956414
SN - 1521-6918
VL - 27
SP - 401
EP - 414
JO - Best Practice and Research: Clinical Gastroenterology
JF - Best Practice and Research: Clinical Gastroenterology
IS - 3
ER -