Refractory Heartburn: A Challenging Problem in Clinical Practice

@article{Domingues2018RefractoryHA,
  title={Refractory Heartburn: A Challenging Problem in Clinical Practice},
  author={Gerson Domingues and Joaquim Prado P Moraes-Filho and Ronnie Fass},
  journal={Digestive Diseases and Sciences},
  year={2018},
  volume={63},
  pages={577-582}
}
AbstractGastroesophageal reflux disease (GERD) is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Heartburn and regurgitation are the typical symptoms of GERD. The treatment of GERD encompasses lifestyle modifications, pharmacological, endoscopic, and surgical therapy. The majority of the patients respond to 4–8 weeks of proton-pump inhibitors therapy, but 20–42% will demonstrate partial or complete lack of response to treatment… 

Efficacy and safety of hangeshashinto for treatment of GERD refractory to proton pump inhibitors

TLDR
HST may be beneficial for patients with PPI-refractory GERD, particularly in non-obese and non-elderly patients with dyspepsia symptoms.

MANIFESTATIONS OF EXCESSIVE DAYTIME SLEEPINESS AND GHRELIN LEVEL IN CASE OF GASTROESOPHAGEAL REFLUX DISEASE IN PATIENTS WITH UNDIFFERENTIATED CONNECTIVE TISSUE DISEASE.

TLDR
GERD manifestations are strongly related to the level to AET and intensity of EDS, and the EDS symptoms depend on circulating ghrelin level.

Impact of nurse practitioner navigation on access to care for patients with refractory gastroesophageal reflux disease.

BACKGROUND Gastroesophageal reflux disease (GERD) is a common digestive complaint that can negatively affect patients' quality of life and have serious complications if inadequately treated. LOCAL

Prevalence of CYP2C19 polymorphism in Bogotá, Colombia: The first report of allele *17

TLDR
The findings show that it is necessary to increase PPI doses in this group of subjects or to use PPIs that are not metabolized by CYP2C19 (rabeprazole), the first Colombian work to identify ultrarapid metabolizers.

GASTROESOPHAGEAL REFLUX DISEASE: A PRACTICAL APPROACH.

TLDR
Most patients benefit from clinical treatment, but surgical treatment may be indicated in the presence of a larger hiatal hernia and complications of the disease.

References

SHOWING 1-10 OF 28 REFERENCES

How to manage refractory GERD

  • J. Richter
  • Medicine
    Nature Clinical Practice Gastroenterology &Hepatology
  • 2007
TLDR
Patients who are unresponsive to 4–8 weeks' treatment with PPIs twice daily might have so-called refractory GERD, which is suggestive of a pill-induced injury, an autoimmune skin disease involving the esophagus, eosinophilic esophagitis or, less likely, a hypersecretory syndrome or a genotype that confers altered metabolism of PPIs.

Management of refractory typical GERD symptoms

TLDR
An outline of a current, usable algorithm for management of patients with rGERD that considers the timing and diagnostic use of pH–impedance monitoring on or off PPI, additional diagnostic tests, the clinical use of baclofen and the use of add-on neuromodulators (tricyclic agents and selective serotonin reuptake inhibitors).

Noncompliance is an impact factor in the treatment of gastroesophageal reflux disease

The basis of pharmacological treatment of the gastroesophageal reflux disease is the use of proton pump inhibitors (PPIs) which provide effective gastric acid secretion blockade. However, PPI therapy

Functional Esophageal Disorders.

TLDR
Treatments directed at improving borderline motor dysfunction or reducing reflux burden to sub-normal levels have limited success in symptom improvement, and strategies focused on modulating peripheral triggering and central perception are mechanistically viable and clinically meaningful.

Patients with refractory reflux symptoms: What do they have and how should they be managed?

TLDR
The major conclusion of the review is that psychogenic factors such as hyperalgesia, allodynia, hypervigilance, and heightened anxiety are the most plausible explanations as the dominant determinants of PPI‐refractory symptoms.

Characteristics of symptomatic reflux episodes in Japanese proton pump inhibitor-refractory non-erosive reflux disease patients.

TLDR
The proximal extent of weakly acidic liquid and mixed liquid-gas reflux is a major factor associated with reflux perception in SI-positive patients on proton pump inhibitor therapy.

Nonmedical Therapeutic Strategies for Nonerosive Reflux Disease

TLDR
Antireflux surgery, in experienced hands, has been repeatedly shown to be efficacious in resolving NERD-related symptoms and psychological therapeutic interventions and alternative medicine techniques, such as acupuncture, continue to show promise, especially in N ERD patients who failed antirefux treatment.

Overlap of reflux and eosinophilic esophagitis in two patients requiring different therapies: a review of the literature.

TLDR
The cases of two young males suffering from dysphagia and recurrent food impaction with reflux esophagitis and more than 20 eo/HPF in upper-mid esophagus biopsies, both of which became asymptomatic on proton pump inhibitor (PPI) therapy, are reported.

Patients with refractory reflux symptoms often do not have GERD

TLDR
The aim of this study was to determine the underlying cause of reflux symptoms not responding to PPI therapy in tertiary referral patients.

Effects of lesogaberan on reflux and lower esophageal sphincter function in patients with gastroesophageal reflux disease.

TLDR
In patients with reflux symptoms despite PPI treatment, lesogaberan decreased the number of TLESRs and reflux episodes, and increased LES pressure compared with placebo, which support further evaluation of lesogsaberan as an add-on treatment in patients partially responding to PPIs.