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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