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Refractory GERD: what is it?
Ronnie Fass1, Anita Gasiorowska
1University of Arizona, Southern Arizona VA Health Care System, GI Section (1-111-GI), 3601 South 6th Avenue, Tucson, AZ 85723-0001, USA. Ronnie.Fass@va.gov
Current Gastroenterology Reports
|July 16, 2008
Summary
Refractory gastroesophageal reflux disease (GERD) affects many patients on proton pump inhibitors (PPIs). Potential causes include reflux type, gut sensitivity, and emptying issues, not typically PPI metabolism or H. pylori.
Area of Science:
- Gastroenterology
- Internal Medicine
Background:
- Refractory gastroesophageal reflux disease (GERD) affects up to 40% of patients on daily proton pump inhibitor (PPI) therapy.
- This condition is characterized by incomplete symptom response or lack of response to standard PPI treatment.
Purpose of the Study:
- To explore the diverse mechanisms contributing to refractory GERD.
- To differentiate refractory GERD from other esophageal and gastric disorders.
Main Methods:
- Review of current literature on refractory GERD.
- Analysis of patient-reported symptoms and potential contributing factors.
Main Results:
- Key mechanisms include weakly acidic reflux, duodenogastroesophageal/bile reflux, visceral hypersensitivity, delayed gastric emptying, psychological factors, and functional bowel disorders.
- Factors like reduced PPI bioavailability, rapid metabolism, PPI resistance, nocturnal reflux, and H. pylori infection play minimal roles.
- Other conditions such as eosinophilic esophagitis, pill-induced esophagitis, Zollinger-Ellison syndrome, and achalasia are rarely the cause of PPI failure.
Conclusions:
- Refractory GERD is multifactorial, with reflux characteristics and gut-brain interactions being primary drivers.
- Thorough patient evaluation is crucial, excluding compliance issues before investigating complex mechanisms.
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