PMID- 23549342
OWN - NLM
STAT- MEDLINE
DCOM- 20140204
LR  - 20130606
IS  - 1531-7056 (Electronic)
IS  - 0267-1379 (Linking)
VI  - 29
IP  - 4
DP  - 2013 Jul
TI  - Management of gastro-oesophageal reflux disease symptoms that do not respond to 
      proton pump inhibitors.
PG  - 431-6
LID - 10.1097/MOG.0b013e328360433c [doi]
AB  - PURPOSE OF REVIEW: Treatment-refractory gastro-oesophageal reflux disease (GERD) 
      remains a significant problem in the gastroenterology clinic. In recent years, 
      several studies have investigated the assessment and treatment of refractory 
      GERD. RECENT FINDINGS: Patients presenting with 'refractory GERD' in fact 
      represent a quite heterogeneous group consisting of those with ongoing 
      reflux-related symptoms and those with reflux-unrelated problems such as 
      functional heartburn, dyspepsia or even eosinophilic oesophagitis. The greatest 
      symptom indicators of persistent true reflux are retrosternal burning and acid 
      taste in the mouth alone. Combined pH-impedance studies allow detection of reflux 
      regardless of pH, and weakly acidic reflux has been suggested as a mechanism of 
      residual symptoms in some patients. The use of reflux-symptom association 
      calculations may help to determine the symptom causation, but refinement and 
      outcome studies are needed. New treatments of refractory GERD have been 
      disappointing. Surgery remains an option in very carefully selected patients, but 
      again better outcome studies are required. SUMMARY: Careful history and 
      investigation is required in the assessment of the proton pump inhibitor 
      (PPI)-refractory patient. Care to exclude alternative diagnoses is needed, and to 
      phenotype those with reflux-related symptoms. Optimization of PPI therapy may 
      help, as may surgery in selected patients.
FAU - Woodland, Philip
AU  - Woodland P
AD  - Barts and The London School of Medicine and Dentistry, Queen Mary, University of 
      London, London, UK.
FAU - Sifrim, Daniel
AU  - Sifrim D
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - United States
TA  - Curr Opin Gastroenterol
JT  - Current opinion in gastroenterology
JID - 8506887
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Esophageal pH Monitoring
MH  - Fundoplication
MH  - Gastroesophageal Reflux/diagnosis/*drug therapy/surgery
MH  - Gastroscopy
MH  - Humans
MH  - Proton Pump Inhibitors/*therapeutic use
MH  - Treatment Failure
EDAT- 2013/04/04 06:00
MHDA- 2014/02/05 06:00
CRDT- 2013/04/04 06:00
PHST- 2013/04/04 06:00 [entrez]
PHST- 2013/04/04 06:00 [pubmed]
PHST- 2014/02/05 06:00 [medline]
AID - 10.1097/MOG.0b013e328360433c [doi]
PST - ppublish
SO  - Curr Opin Gastroenterol. 2013 Jul;29(4):431-6. doi: 10.1097/MOG.0b013e328360433c.