Abstract
Purpose of the review to present up-to-date data on the causes, methods of diagnosis and treatment of the refractory form of gastroesophageal reflux disease (GERD). Refractory GERD is the preservation of typical symptoms of the disease and/or incomplete healing of the esophageal mucosa against the background of taking a standard dose of proton pump inhibitors (PPI) once a day for 8 weeks. The reasons for the lack of response to the treatment are divided into related to the patient, related to therapy, and not related to GERD. Diagnostic approaches include x-ray examination of the esophagus and stomach, endoscopy with biopsy, 24-hour Impedance-pH monitoring, esophageal manometry. Depending on the reasons for the lack of response to the therapy, treatment may include lifestyle changes, doubling the dose of PPI, replacing PPI with another, adding H2-receptor antagonists, prokinetics, antacids, alginates and adsorbents. If conservative treatment is ineffective, it is possible to consider alternative methods, such as surgical treatment. Refractory GERD is a serious clinical problem. The absence of an answer to 8-week therapy with PPI requires a thorough differential diagnosis using additional examination methods. The identification of the causes of refractory to the therapy allows to optimize the approaches to its overcoming and to choose the optimal treatment.
Highlights
Refractory gastroesophageal reflux disease (GERD) is the preservation of typical symptoms of the disease and/or incomplete healing of the esophageal mucosa against the background of taking a standard dose of proton pump inhibitors (PPI) once a day for 8 weeks
У больных с рефрактерным течением Гастроэзофагеальная рефлюксная болезнь (ГЭРБ) следует учитывать генетический полиморфизм цитохрома Р450, время приема препарата, клиническую картину заболевания и выбирать наиболее эффективный ингибиторами протонной помпы (ИПП)
Summary
Многие пациенты прекращают прием препарата при купировании симптомов, и только 55% принимают стандартную дозу ИПП в течение рекомендованных 4 нед, в то время как 37% – в течение менее 12 дней [9, 10]. ГПОД является не только важным фактором развития ГЭРБ, но также может приводить к отсутствию у пациентов ответа на проводимую терапию ИПП. НКП встречается у 70% пациентов и повышает вероятность повреждения пищевода и сохранения клинических симптомов, так как сопровождается кислыми ГЭР у больных с неосложненной ГЭРБ в 15% случаев, у больных с тяжелыми эзофагитами, пищеводом Баррета и склеродермией – в 50%, в то время как у здоровых субъектов – в 5% [39].
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