Proton pump inhibitor (PPI) therapy is the mainstay of treatment for gastroesophageal reflux disease (GERD). However, up to 30% of patients with reflux symptoms report inadequate symptom control with PPI therapy. PPI-refractory GERD should be suspected when troublesome reflux symptoms persist after 4-week standard dosage and 8-week high-dosage PPI therapy. Impedance-pH monitoring represents the gold standard for investigating the mechanism(s) of PPI refractoriness and for distinguishing patients with reflux-related from those with reflux-unrelated PPI-refractory syndromes. New impedance parameters, namely the postreflux swallow-induced peristaltic wave (PSPW) index and mean nocturnal baseline impedance (MNBI), have significantly increased the diagnostic yield of impedance-pH monitoring. Currently, laparoscopic fundoplication in experienced hands represents a treatment modality of documented efficacy in patients with PPI-refractory GERD.
Proton pump inhibitor-refractory gastroesophageal reflux disease: Current diagnosis & management / Frazzoni, Leonardo; Fuccio, Lorenzo; Frazzoni, Marzio. - In: MINERVA GASTROENTEROLOGICA E DIETOLOGICA. - ISSN 1121-421X. - STAMPA. - 63:3(2017), pp. 249-256. [10.23736/S1121-421X.17.02392-3]
Proton pump inhibitor-refractory gastroesophageal reflux disease: Current diagnosis & management
Frazzoni, Leonardo;FUCCIO, LORENZO;
2017
Abstract
Proton pump inhibitor (PPI) therapy is the mainstay of treatment for gastroesophageal reflux disease (GERD). However, up to 30% of patients with reflux symptoms report inadequate symptom control with PPI therapy. PPI-refractory GERD should be suspected when troublesome reflux symptoms persist after 4-week standard dosage and 8-week high-dosage PPI therapy. Impedance-pH monitoring represents the gold standard for investigating the mechanism(s) of PPI refractoriness and for distinguishing patients with reflux-related from those with reflux-unrelated PPI-refractory syndromes. New impedance parameters, namely the postreflux swallow-induced peristaltic wave (PSPW) index and mean nocturnal baseline impedance (MNBI), have significantly increased the diagnostic yield of impedance-pH monitoring. Currently, laparoscopic fundoplication in experienced hands represents a treatment modality of documented efficacy in patients with PPI-refractory GERD.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.