REVIEW  GERD: THE NEVERENDING STORY 

Minerva Gastroenterologica e Dietologica 2017 September;63(3):249-56

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

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Proton pump inhibitor-refractory gastroesophageal reflux disease: 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

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 postreflux 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: Gastroesophageal reflux - Proton pump inhibitors - Therapeutics