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Published on: August 25, 2015
Refractory gastrooesophageal reflux disease
Albert J Bredenoord1, André J Smout
1Department of Gastroenterology, Sint Antonius Hospital, Nieuwegein, The Netherlands. a.bredenoord@antonius.net
European Journal of Gastroenterology & Hepatology
|February 28, 2008
Summary
Proton pump inhibitors (PPIs) effectively treat gastroesophageal reflux disease (GORD), but some patients remain resistant. Reconsidering the GORD diagnosis is crucial, as other conditions like functional dyspepsia are often the cause.
Area of Science:
- Gastroenterology
- Pharmacology
Background:
- Proton pump inhibitors (PPIs) have significantly improved gastroesophageal reflux disease (GORD) management.
- A subset of patients exhibits therapy resistance, posing a common clinical challenge.
Purpose of the Study:
- To investigate the causes and diagnostic considerations for PPI-refractory GORD.
- To differentiate true PPI-refractory GORD from other gastrointestinal disorders.
Main Methods:
- Review of existing literature on PPI treatment variability and refractory GORD.
- Discussion of diagnostic approaches including patient history, upper endoscopy, and reflux monitoring.
Main Results:
- PPI treatment efficacy varies based on compliance, H. pylori status, and genotype.
- Nocturnal acid breakthrough is not a primary driver of refractory GORD.
- Nonacid reflux episodes and other disorders like functional dyspepsia are common causes of PPI treatment failure.
Conclusions:
- Re-evaluating the GORD diagnosis is essential for patients unresponsive to PPIs.
- Functional dyspepsia should be considered in PPI-refractory cases.
- For confirmed PPI-refractory GORD, options include managing esophageal hypersensitivity or surgical intervention.
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