Gastro-esophageal reflux disease (GERD) is one of the most prevalent chronic diseases. Although proton pumpinhibitors (PPIs) represent the mainstay of treatmentboth for healing erosive esophagitis and for symptomrelief, several studies have shown that up to 40% ofGERD patients reported either partial or complete lackof response of their symptoms to a standard PPI doseonce daily. Several mechanisms have been proposed asinvolved in PPIs resistance, including ineffective controlof gastric acid secretion, esophageal hypersensitivity,ultrastructural and functional changes in the esophagealepithelium. The diagnostic evaluation of a refractoryGERD patients should include an accurate clinicalevaluation, upper endoscopy, esophageal manometryand ambulatory pH-impedance monitoring, which allowsto discriminate non-erosive reflux disease patientsfrom those presenting esophageal hypersensitivity orfunctional heartburn. Treatment has been primarilybased on doubling the PPI dose or switching to anotherPPI. Patients with proven disease, not responding toPPI twice daily, are eligible for anti-reflux surgery.

Proton pump inhibitor resistance, the real challenge in gastro-esophageal reflux disease

Cicala M;Emerenziani S;GUARINO M;Ribolsi M
2013-01-01

Abstract

Gastro-esophageal reflux disease (GERD) is one of the most prevalent chronic diseases. Although proton pumpinhibitors (PPIs) represent the mainstay of treatmentboth for healing erosive esophagitis and for symptomrelief, several studies have shown that up to 40% ofGERD patients reported either partial or complete lackof response of their symptoms to a standard PPI doseonce daily. Several mechanisms have been proposed asinvolved in PPIs resistance, including ineffective controlof gastric acid secretion, esophageal hypersensitivity,ultrastructural and functional changes in the esophagealepithelium. The diagnostic evaluation of a refractoryGERD patients should include an accurate clinicalevaluation, upper endoscopy, esophageal manometryand ambulatory pH-impedance monitoring, which allowsto discriminate non-erosive reflux disease patientsfrom those presenting esophageal hypersensitivity orfunctional heartburn. Treatment has been primarilybased on doubling the PPI dose or switching to anotherPPI. Patients with proven disease, not responding toPPI twice daily, are eligible for anti-reflux surgery.
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.12610/2954
Citazioni
  • ???jsp.display-item.citation.pmc??? 16
  • Scopus 67
  • ???jsp.display-item.citation.isi??? 56
social impact