PPI-refractory GERD: current diagnosis and management.

PPI-refractory GERD: current diagnosis and management. Minerva Gastroenterol Dietol. 2017 Mar 01;: Authors: Frazzoni L, Fuccio L, Frazzoni M 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 post-reflux 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. PMID: 28251845 [PubMed - as supplied by publisher]
Source: Minerva Gastroenterologica e Dietologica - Category: Gastroenterology Tags: Minerva Gastroenterol Dietol Source Type: research