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MINERVA GASTROENTEROLOGICA E DIETOLOGICA

Rivista di Gastroenterologia, Nutrizione e Dietetica


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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

lingua: Inglese

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


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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 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

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Publication History

Issue published online: June 19, 2017
Article first published online: March 1, 2017

Per citare questo articolo

Frazzoni L, Fuccio L, Frazzoni M. Proton pump inhibitor-refractory gastroesophageal reflux disease: current diagnosis and management. Minerva Gastroenterol Dietol 2017;63:249-56. DOI: 10.23736/S1121-421X.17.02392-3

Corresponding author e-mail

marziofrazzoni@gmail.com