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Proton pump inhibitor resistance, the real challenge in gastro-esophageal reflux disease.
World J Gastroenterol. 2013 Oct 21; 19(39):6529-35.WJ

Abstract

Gastro-esophageal reflux disease (GERD) is one of the most prevalent chronic diseases. Although proton pump inhibitors (PPIs) represent the mainstay of treatment both for healing erosive esophagitis and for symptom relief, several studies have shown that up to 40% of GERD patients reported either partial or complete lack of response of their symptoms to a standard PPI dose once daily. Several mechanisms have been proposed as involved in PPIs resistance, including ineffective control of gastric acid secretion, esophageal hypersensitivity, ultrastructural and functional changes in the esophageal epithelium. The diagnostic evaluation of a refractory GERD patients should include an accurate clinical evaluation, upper endoscopy, esophageal manometry and ambulatory pH-impedance monitoring, which allows to discriminate non-erosive reflux disease patients from those presenting esophageal hypersensitivity or functional heartburn. Treatment has been primarily based on doubling the PPI dose or switching to another PPI. Patients with proven disease, not responding to PPI twice daily, are eligible for anti-reflux surgery.

Authors+Show Affiliations

Michele Cicala, Sara Emerenziani, Michele Pier Luca Guarino, Mentore Ribolsi, Unit of Digestive Disease, Campus Bio Medico University of Rome, 00128 Rome, Italy.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

24151377

Citation

Cicala, Michele, et al. "Proton Pump Inhibitor Resistance, the Real Challenge in Gastro-esophageal Reflux Disease." World Journal of Gastroenterology, vol. 19, no. 39, 2013, pp. 6529-35.
Cicala M, Emerenziani S, Guarino MP, et al. Proton pump inhibitor resistance, the real challenge in gastro-esophageal reflux disease. World J Gastroenterol. 2013;19(39):6529-35.
Cicala, M., Emerenziani, S., Guarino, M. P., & Ribolsi, M. (2013). Proton pump inhibitor resistance, the real challenge in gastro-esophageal reflux disease. World Journal of Gastroenterology, 19(39), 6529-35. https://doi.org/10.3748/wjg.v19.i39.6529
Cicala M, et al. Proton Pump Inhibitor Resistance, the Real Challenge in Gastro-esophageal Reflux Disease. World J Gastroenterol. 2013 Oct 21;19(39):6529-35. PubMed PMID: 24151377.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Proton pump inhibitor resistance, the real challenge in gastro-esophageal reflux disease. AU - Cicala,Michele, AU - Emerenziani,Sara, AU - Guarino,Michele Pier Luca, AU - Ribolsi,Mentore, PY - 2013/06/25/received PY - 2013/07/31/revised PY - 2013/08/16/accepted PY - 2013/10/24/entrez PY - 2013/10/24/pubmed PY - 2014/4/5/medline KW - Ambulatory pH-impedance monitoring KW - Esophageal hypersensitivity KW - Gastro-esophageal reflux disease KW - Gastro-esophageal reflux disease treatment KW - Proton pump inhibitor SP - 6529 EP - 35 JF - World journal of gastroenterology JO - World J. Gastroenterol. VL - 19 IS - 39 N2 - Gastro-esophageal reflux disease (GERD) is one of the most prevalent chronic diseases. Although proton pump inhibitors (PPIs) represent the mainstay of treatment both for healing erosive esophagitis and for symptom relief, several studies have shown that up to 40% of GERD patients reported either partial or complete lack of response of their symptoms to a standard PPI dose once daily. Several mechanisms have been proposed as involved in PPIs resistance, including ineffective control of gastric acid secretion, esophageal hypersensitivity, ultrastructural and functional changes in the esophageal epithelium. The diagnostic evaluation of a refractory GERD patients should include an accurate clinical evaluation, upper endoscopy, esophageal manometry and ambulatory pH-impedance monitoring, which allows to discriminate non-erosive reflux disease patients from those presenting esophageal hypersensitivity or functional heartburn. Treatment has been primarily based on doubling the PPI dose or switching to another PPI. Patients with proven disease, not responding to PPI twice daily, are eligible for anti-reflux surgery. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/24151377/Proton_pump_inhibitor_resistance_the_real_challenge_in_gastro_esophageal_reflux_disease_ L2 - http://www.wjgnet.com/1007-9327/full/v19/i39/6529.htm DB - PRIME DP - Unbound Medicine ER -