PMID- 30240968
OWN - NLM
STAT- MEDLINE
DCOM- 20191022
LR  - 20191022
IS  - 1471-4973 (Electronic)
IS  - 1471-4892 (Linking)
VI  - 43
DP  - 2018 Dec
TI  - Refractory GERD, beyond proton pump inhibitors.
PG  - 99-103
LID - S1471-4892(18)30045-6 [pii]
LID - 10.1016/j.coph.2018.09.001 [doi]
AB  - Pharmacologic therapy, surgery, minimally invasive therapies, and alternative 
      therapies are different options available for the management of refractory GERD. 
      The choice may depend on the cause of refractoriness. Increased gastric acid 
      suppression therapy might be useful in the rare patients with persistent elevated 
      esophageal acid exposure on proton pump inhibitors (PPI). Potassium-competitive 
      acid blockers (P-CAB) might induce a more important acid inhibition than PPI. 
      Baclofen might act as a reflux inhibitor and demonstrates a significant efficacy 
      in rumination syndrome. The role of topical antacid-alginate in refractory GERD 
      might be limited. Surgery might be a valid option in case of persistent 
      pathological acid esophageal exposure despite PPI. Further evaluation of 
      minimally invasive procedures is necessary. Finally diet, diaphragmatic breathing 
      and transcutaneous electrical acustimulation might be of interest in patients 
      with esophageal hypersensivity or functional symptoms.
CI  - Copyright (c) 2018 Elsevier Ltd. All rights reserved.
FAU - Roman, Sabine
AU  - Roman S
AD  - Universite de Lyon, Hospices Civils de Lyon, Digestive Physiology, Hopital E 
      Herriot, F-69437, Lyon, France; Universite de Lyon, Lyon I University, Digestive 
      Physiology, F-69008, Lyon, France; Universite de Lyon, Inserm U1032, LabTAU, 
      F-69008, Lyon, France. Electronic address: sabine.roman@chu-lyon.fr.
FAU - Mion, Francois
AU  - Mion F
AD  - Universite de Lyon, Hospices Civils de Lyon, Digestive Physiology, Hopital E 
      Herriot, F-69437, Lyon, France; Universite de Lyon, Lyon I University, Digestive 
      Physiology, F-69008, Lyon, France; Universite de Lyon, Inserm U1032, LabTAU, 
      F-69008, Lyon, France.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20180918
PL  - England
TA  - Curr Opin Pharmacol
JT  - Current opinion in pharmacology
JID - 100966133
RN  - 0 (Gastrointestinal Agents)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Animals
MH  - Clinical Decision-Making
MH  - Complementary Therapies
MH  - *Digestive System Surgical Procedures/adverse effects
MH  - Gastric Acid/*metabolism
MH  - *Gastric Mucosa/drug effects/metabolism/physiopathology/surgery
MH  - Gastroesophageal Reflux/diet therapy/metabolism/physiopathology/*therapy
MH  - Gastrointestinal Agents/adverse effects/*therapeutic use
MH  - Humans
MH  - Hydrogen-Ion Concentration
MH  - Patient Selection
MH  - Proton Pump Inhibitors/therapeutic use
MH  - Risk Factors
MH  - Treatment Outcome
EDAT- 2018/09/22 06:00
MHDA- 2019/10/23 06:00
CRDT- 2018/09/22 06:00
PHST- 2018/06/22 00:00 [received]
PHST- 2018/08/27 00:00 [revised]
PHST- 2018/09/03 00:00 [accepted]
PHST- 2018/09/22 06:00 [pubmed]
PHST- 2019/10/23 06:00 [medline]
PHST- 2018/09/22 06:00 [entrez]
AID - S1471-4892(18)30045-6 [pii]
AID - 10.1016/j.coph.2018.09.001 [doi]
PST - ppublish
SO  - Curr Opin Pharmacol. 2018 Dec;43:99-103. doi: 10.1016/j.coph.2018.09.001. Epub 
      2018 Sep 18.