Heartburn refractory to proton-pump inhibitors

Area of Science:

• Gastroenterology
• Digestive Health
• Clinical Medicine

Background:

• Heartburn persisting despite proton-pump inhibitor (PPI) therapy presents a diagnostic challenge.
• Patients may experience refractory symptoms due to uncontrolled acid exposure or other causes like hypersensitivity or functional heartburn.
• Current diagnostic and therapeutic strategies for PPI-refractory heartburn are not well-established.

Purpose of the Study:

• To determine the most effective diagnostic and therapeutic approach for patients with heartburn refractory to PPIs.
• To identify the underlying causes of persistent heartburn in patients on PPI therapy.
• To guide clinical decision-making for managing refractory heartburn.

Main Methods:

• Utilizing 24-hour pH and multichannel intraluminal impedance monitoring with symptom index during high-dose PPI therapy.
• Categorizing patients based on esophageal acid exposure and symptom correlation.
• Evaluating potential etiologies including PPI failure, hypersensitivity, nonacid reflux, and functional heartburn.

Main Results:

• A significant proportion of patients with PPI-refractory heartburn have controlled acid exposure.
• Functional heartburn is a common diagnosis in patients with persistent symptoms despite PPIs.
• Diagnostic testing helps differentiate causes and guides treatment decisions.

Conclusions:

• 24-hour pH and multichannel intraluminal impedance monitoring is a clinically useful diagnostic tool for refractory heartburn.
• Identifying functional heartburn discourages invasive endoscopic or surgical interventions.
• Therapeutic strategies should be guided by diagnostic findings due to limited evidence for specific treatments.