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MINERVA GASTROENTEROLOGICA E DIETOLOGICA

A Journal on Gastroenterology, Nutrition and Dietetics


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Minerva Gastroenterologica e Dietologica 2017 Mar 01

DOI: 10.23736/S1121-421X.17.02392-3

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

PPI-refractory GERD: current diagnosis and management

Leonardo FRAZZONI 1, Lorenzo FUCCIO 1, Marzio FRAZZONI 2

1 Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; 2 Digestive Pathophysiology Unit, Baggiovara Hospital, Modena, Italy


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Proton pump inhibitor (PPI) therapy is the mainstay of treatment for gastroesophageal reflux disease (GERD). However, up to 30% of patients with reflux symptoms report inadequate symptom control with PPI therapy. PPI-refractory GERD should be suspected when troublesome reflux symptoms persist after 4-week standard dosage and 8-week high-dosage PPI therapy. Impedance-pH monitoring represents the gold standard for investigating the mechanism(s) of PPI refractoriness and for distinguishing patients with reflux-related from those with reflux- unrelated PPI-refractory syndromes. New impedance parameters, namely the post-reflux swallow-induced peristaltic wave (PSPW) index and mean nocturnal baseline impedance (MNBI), have significantly increased the diagnostic yield of impedance-pH monitoring. Currently, laparoscopic fundoplication in experienced hands represents a treatment modality of documented efficacy in patients with PPI-refractory GERD.


KEY WORDS: Refractory GERD – Impedance-pH monitoring – Laparoscopic fundoplication

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marziofrazzoni@gmail.com