Management of the Patient with Incomplete Response to PPI Therapy
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TLDR
Diagnostic testing (pH or pH-impedance monitoring) becomes essential with an incomplete PPI response, obtaining an accurate history, detailing which symptoms are 'refractory' and exactly what evidence exists linking these symptoms to GERD is paramount.Abstract:
Proton pump inhibitors (PPIs) remove most of the acid from the gastroesophageal refluxate. However, PPIs do not eliminate reflux and the response of specific GERD symptoms to PPI therapy depends on the degree to which acid drives those symptoms. PPIs are progressively less effective for heartburn, regurgitation, chest pain and extra-oesophageal symptoms. Hence, with an incomplete PPI response, obtaining an accurate history, detailing which symptoms are ‘refractory’ and exactly what evidence exists linking these symptoms to GERD is paramount. Reflux can continue to cause symptoms despite PPI therapy because of persistent acid reflux or weakly acidic reflux. Given these possibilities, diagnostic testing (pH or pH-impedance monitoring) becomes essential. Antireflux surgery is an alternative in patients if a clear relationship is established between persistent symptoms, particularly regurgitation, and reflux. Treating visceral hypersensitivity may also benefit the subset of GERD patients whose symptoms are driven by this mechanism.read more
Citations
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Modern diagnosis of GERD: the Lyon Consensus
C. Prakash Gyawali,Peter J. Kahrilas,Edoardo Savarino,Frank Zerbib,François Mion,François Mion,André J.P.M. Smout,Michael F. Vaezi,Daniel Sifrim,Mark A. Fox,Marcelo F. Vela,Radu Tutuian,Jan Tack,Albert J. Bredenoord,John E. Pandolfino,Sabine Roman,Sabine Roman +16 more
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Philip O. Katz,Kerry B. Dunbar,Felice Schnoll-Sussman,Katarina B. Greer,Rena Yadlapati,Stuart J. Spechler +5 more
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