Management of the patient with incomplete response to PPI therapy

Peter J. Kahrilas*, Guy Boeckxstaens, Andre J.P.M. Smout

*Corresponding author for this work

Research output: Contribution to journalReview article

26 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)401-414
Number of pages14
JournalBest Practice and Research: Clinical Gastroenterology
Volume27
Issue number3
DOIs
Publication statusPublished - Jan 1 2013

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Keywords

  • Ambulatory oesophageal
  • Ambulatory oesophageal pH-impedance monitoring
  • Gastroesophageal reflux disease
  • Oesophagus
  • Proton pump inhibitors
  • Visceral hypersensitivity
  • pH monitoring

ASJC Scopus subject areas

  • Gastroenterology

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