Proton pump inhibitor-refractory gastroesophageal reflux disease: challenges and solutions
Joseph Mermelstein,1 Alanna Chait Mermelstein,2 Maxwell M Chait3 1Gasteroenterology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; 2Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA;...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2018-03-01
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| Series: | Clinical and Experimental Gastroenterology |
| Subjects: | |
| Online Access: | https://www.dovepress.com/proton-pump-inhibitor-refractory-gastroesophageal-reflux-disease-chall-peer-reviewed-article-CEG |
| _version_ | 1818480919948820480 |
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| author | Mermelstein J Chait Mermelstein A Chait MM |
| author_facet | Mermelstein J Chait Mermelstein A Chait MM |
| author_sort | Mermelstein J |
| collection | DOAJ |
| description | Joseph Mermelstein,1 Alanna Chait Mermelstein,2 Maxwell M Chait3 1Gasteroenterology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; 2Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA; 3Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA Abstract: A significant percentage of patients with gastroesophageal reflux disease (GERD) will not respond to proton pump inhibitor (PPI) therapy. The causes of PPI-refractory GERD are numerous and diverse, and include adherence, persistent acid, functional disorders, nonacid reflux, and PPI bioavailability. The evaluation should start with a symptom assessment and may progress to imaging, endoscopy, and monitoring of esophageal pH, impedance, and bilirubin. There are a variety of pharmacologic and procedural interventions that should be selected based on the underlying mechanism of PPI failure. Pharmacologic treatments can include antacids, prokinetics, alginates, bile acid binders, reflux inhibitors, and antidepressants. Procedural options include laparoscopic fundoplication and LINX as well as endoscopic procedures, such as transoral incisionless fundoplication and Stretta. Several alternative and complementary treatments of possible benefit also exist. Keywords: PPI failure, resistant GERD, acid-related diseases, gastroesophageal reflux disease, acid reflux, proton pump inhibitors |
| first_indexed | 2024-12-10T11:28:33Z |
| format | Article |
| id | doaj.art-3dafb895deb641bb971cba22623a9bc0 |
| institution | Directory Open Access Journal |
| issn | 1178-7023 |
| language | English |
| last_indexed | 2024-12-10T11:28:33Z |
| publishDate | 2018-03-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Clinical and Experimental Gastroenterology |
| spelling | doaj.art-3dafb895deb641bb971cba22623a9bc02022-12-22T01:50:39ZengDove Medical PressClinical and Experimental Gastroenterology1178-70232018-03-01Volume 1111913437356Proton pump inhibitor-refractory gastroesophageal reflux disease: challenges and solutionsMermelstein JChait Mermelstein AChait MMJoseph Mermelstein,1 Alanna Chait Mermelstein,2 Maxwell M Chait3 1Gasteroenterology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; 2Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA; 3Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA Abstract: A significant percentage of patients with gastroesophageal reflux disease (GERD) will not respond to proton pump inhibitor (PPI) therapy. The causes of PPI-refractory GERD are numerous and diverse, and include adherence, persistent acid, functional disorders, nonacid reflux, and PPI bioavailability. The evaluation should start with a symptom assessment and may progress to imaging, endoscopy, and monitoring of esophageal pH, impedance, and bilirubin. There are a variety of pharmacologic and procedural interventions that should be selected based on the underlying mechanism of PPI failure. Pharmacologic treatments can include antacids, prokinetics, alginates, bile acid binders, reflux inhibitors, and antidepressants. Procedural options include laparoscopic fundoplication and LINX as well as endoscopic procedures, such as transoral incisionless fundoplication and Stretta. Several alternative and complementary treatments of possible benefit also exist. Keywords: PPI failure, resistant GERD, acid-related diseases, gastroesophageal reflux disease, acid reflux, proton pump inhibitorshttps://www.dovepress.com/proton-pump-inhibitor-refractory-gastroesophageal-reflux-disease-chall-peer-reviewed-article-CEGPPI failureResistant GERDacid-related diseases |
| spellingShingle | Mermelstein J Chait Mermelstein A Chait MM Proton pump inhibitor-refractory gastroesophageal reflux disease: challenges and solutions Clinical and Experimental Gastroenterology PPI failure Resistant GERD acid-related diseases |
| title | Proton pump inhibitor-refractory gastroesophageal reflux disease: challenges and solutions |
| title_full | Proton pump inhibitor-refractory gastroesophageal reflux disease: challenges and solutions |
| title_fullStr | Proton pump inhibitor-refractory gastroesophageal reflux disease: challenges and solutions |
| title_full_unstemmed | Proton pump inhibitor-refractory gastroesophageal reflux disease: challenges and solutions |
| title_short | Proton pump inhibitor-refractory gastroesophageal reflux disease: challenges and solutions |
| title_sort | proton pump inhibitor refractory gastroesophageal reflux disease challenges and solutions |
| topic | PPI failure Resistant GERD acid-related diseases |
| url | https://www.dovepress.com/proton-pump-inhibitor-refractory-gastroesophageal-reflux-disease-chall-peer-reviewed-article-CEG |
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