Refractory Gastroesophageal Reflux Disease: A Management Update
Gastroesophageal reflux disease (GERD) is one of the most frequent gastrointestinal disorders. Proton pump inhibitors (PPIs) are effective in healing lesions and improving symptoms in most cases, although up to 40% of GERD patients do not respond adequately to PPI therapy. Refractory GERD (rGERD) is...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-11-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2021.765061/full |
| _version_ | 1819033444321067008 |
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| author | Francesco Rettura Francesco Bronzini Michele Campigotto Christian Lambiase Andrea Pancetti Ginevra Berti Santino Marchi Nicola de Bortoli Frank Zerbib Edoardo Savarino Massimo Bellini |
| author_facet | Francesco Rettura Francesco Bronzini Michele Campigotto Christian Lambiase Andrea Pancetti Ginevra Berti Santino Marchi Nicola de Bortoli Frank Zerbib Edoardo Savarino Massimo Bellini |
| author_sort | Francesco Rettura |
| collection | DOAJ |
| description | Gastroesophageal reflux disease (GERD) is one of the most frequent gastrointestinal disorders. Proton pump inhibitors (PPIs) are effective in healing lesions and improving symptoms in most cases, although up to 40% of GERD patients do not respond adequately to PPI therapy. Refractory GERD (rGERD) is one of the most challenging problems, given its impact on the quality of life and consumption of health care resources. The definition of rGERD is a controversial topic as it has not been unequivocally established. Indeed, some patients unresponsive to PPIs who experience symptoms potentially related to GERD may not have GERD; in this case the definition could be replaced with “reflux-like PPI-refractory symptoms.” Patients with persistent reflux-like symptoms should undergo a diagnostic workup aimed at finding objective evidence of GERD through endoscopic and pH-impedance investigations. The management strategies regarding rGERD, apart from a careful check of patient's compliance with PPIs, a possible change in the timing of their administration and the choice of a PPI with a different metabolic pathway, include other pharmacologic treatments. These include histamine-2 receptor antagonists (H2RAs), alginates, antacids and mucosal protective agents, potassium competitive acid blockers (PCABs), prokinetics, gamma aminobutyric acid-B (GABA-B) receptor agonists and metabotropic glutamate receptor-5 (mGluR5) antagonists, and pain modulators. If there is no benefit from medical therapy, but there is objective evidence of GERD, invasive antireflux options should be evaluated after having carefully explained the risks and benefits to the patient. The most widely performed invasive antireflux option remains laparoscopic antireflux surgery (LARS), even if other, less invasive, interventions have been suggested in the last few decades, including endoscopic transoral incisionless fundoplication (TIF), magnetic sphincter augmentation (LINX) or radiofrequency therapy (Stretta). Due to the different mechanisms underlying rGERD, the most effective strategy can vary, and it should be tailored to each patient. The aim of this paper is to review the different management options available to successfully deal with rGERD. |
| first_indexed | 2024-12-21T07:17:56Z |
| format | Article |
| id | doaj.art-b22b5df2d57f4ee3b6a08e901f4eff98 |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-21T07:17:56Z |
| publishDate | 2021-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-b22b5df2d57f4ee3b6a08e901f4eff982022-12-21T19:11:50ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2021-11-01810.3389/fmed.2021.765061765061Refractory Gastroesophageal Reflux Disease: A Management UpdateFrancesco Rettura0Francesco Bronzini1Michele Campigotto2Christian Lambiase3Andrea Pancetti4Ginevra Berti5Santino Marchi6Nicola de Bortoli7Frank Zerbib8Edoardo Savarino9Massimo Bellini10Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, ItalyDivision of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, ItalyDepartment of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, ItalyDivision of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, ItalyDivision of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, ItalyDivision of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, ItalyDivision of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, ItalyDivision of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, ItalyCHU de Bordeaux, Centre Medico-Chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, Bordeaux, FranceDivision of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, ItalyDivision of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, ItalyGastroesophageal reflux disease (GERD) is one of the most frequent gastrointestinal disorders. Proton pump inhibitors (PPIs) are effective in healing lesions and improving symptoms in most cases, although up to 40% of GERD patients do not respond adequately to PPI therapy. Refractory GERD (rGERD) is one of the most challenging problems, given its impact on the quality of life and consumption of health care resources. The definition of rGERD is a controversial topic as it has not been unequivocally established. Indeed, some patients unresponsive to PPIs who experience symptoms potentially related to GERD may not have GERD; in this case the definition could be replaced with “reflux-like PPI-refractory symptoms.” Patients with persistent reflux-like symptoms should undergo a diagnostic workup aimed at finding objective evidence of GERD through endoscopic and pH-impedance investigations. The management strategies regarding rGERD, apart from a careful check of patient's compliance with PPIs, a possible change in the timing of their administration and the choice of a PPI with a different metabolic pathway, include other pharmacologic treatments. These include histamine-2 receptor antagonists (H2RAs), alginates, antacids and mucosal protective agents, potassium competitive acid blockers (PCABs), prokinetics, gamma aminobutyric acid-B (GABA-B) receptor agonists and metabotropic glutamate receptor-5 (mGluR5) antagonists, and pain modulators. If there is no benefit from medical therapy, but there is objective evidence of GERD, invasive antireflux options should be evaluated after having carefully explained the risks and benefits to the patient. The most widely performed invasive antireflux option remains laparoscopic antireflux surgery (LARS), even if other, less invasive, interventions have been suggested in the last few decades, including endoscopic transoral incisionless fundoplication (TIF), magnetic sphincter augmentation (LINX) or radiofrequency therapy (Stretta). Due to the different mechanisms underlying rGERD, the most effective strategy can vary, and it should be tailored to each patient. The aim of this paper is to review the different management options available to successfully deal with rGERD.https://www.frontiersin.org/articles/10.3389/fmed.2021.765061/fullgastroesophageal reflux disease (GERD)refractory GERD (rGERD)24-h multichannel intraluminal impedance-pH (MII-pH)proton pump inhibitors (PPIs)laparoscopic antireflux surgery (LARS) |
| spellingShingle | Francesco Rettura Francesco Bronzini Michele Campigotto Christian Lambiase Andrea Pancetti Ginevra Berti Santino Marchi Nicola de Bortoli Frank Zerbib Edoardo Savarino Massimo Bellini Refractory Gastroesophageal Reflux Disease: A Management Update Frontiers in Medicine gastroesophageal reflux disease (GERD) refractory GERD (rGERD) 24-h multichannel intraluminal impedance-pH (MII-pH) proton pump inhibitors (PPIs) laparoscopic antireflux surgery (LARS) |
| title | Refractory Gastroesophageal Reflux Disease: A Management Update |
| title_full | Refractory Gastroesophageal Reflux Disease: A Management Update |
| title_fullStr | Refractory Gastroesophageal Reflux Disease: A Management Update |
| title_full_unstemmed | Refractory Gastroesophageal Reflux Disease: A Management Update |
| title_short | Refractory Gastroesophageal Reflux Disease: A Management Update |
| title_sort | refractory gastroesophageal reflux disease a management update |
| topic | gastroesophageal reflux disease (GERD) refractory GERD (rGERD) 24-h multichannel intraluminal impedance-pH (MII-pH) proton pump inhibitors (PPIs) laparoscopic antireflux surgery (LARS) |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2021.765061/full |
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