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Proton pump inhibitor-refractory gastroesophageal reflux disease: current diagnosis and management.
Minerva Gastroenterol Dietol. 2017 Sep; 63(3):249-256.MG

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.

Authors+Show Affiliations

Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.Digestive Pathophysiology Unit, Baggiovara Hospital, Modena, Italy - marziofrazzoni@gmail.com.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

28251845

Citation

Frazzoni, Leonardo, et al. "Proton Pump Inhibitor-refractory Gastroesophageal Reflux Disease: Current Diagnosis and Management." Minerva Gastroenterologica E Dietologica, vol. 63, no. 3, 2017, pp. 249-256.
Frazzoni L, Fuccio L, Frazzoni M. Proton pump inhibitor-refractory gastroesophageal reflux disease: current diagnosis and management. Minerva Gastroenterol Dietol. 2017;63(3):249-256.
Frazzoni, L., Fuccio, L., & Frazzoni, M. (2017). Proton pump inhibitor-refractory gastroesophageal reflux disease: current diagnosis and management. Minerva Gastroenterologica E Dietologica, 63(3), 249-256. https://doi.org/10.23736/S1121-421X.17.02392-3
Frazzoni L, Fuccio L, Frazzoni M. Proton Pump Inhibitor-refractory Gastroesophageal Reflux Disease: Current Diagnosis and Management. Minerva Gastroenterol Dietol. 2017;63(3):249-256. PubMed PMID: 28251845.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Proton pump inhibitor-refractory gastroesophageal reflux disease: current diagnosis and management. AU - Frazzoni,Leonardo, AU - Fuccio,Lorenzo, AU - Frazzoni,Marzio, Y1 - 2017/03/01/ PY - 2017/3/3/pubmed PY - 2018/5/18/medline PY - 2017/3/3/entrez SP - 249 EP - 256 JF - Minerva gastroenterologica e dietologica JO - Minerva Gastroenterol Dietol VL - 63 IS - 3 N2 - 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. SN - 1827-1642 UR - https://www.unboundmedicine.com/medline/citation/28251845/Proton_pump_inhibitor_refractory_gastroesophageal_reflux_disease:_current_diagnosis_and_management_ L2 - http://www.minervamedica.it/index2.t?show=R08Y2017N03A0249 DB - PRIME DP - Unbound Medicine ER -