Gastroesophageal Reflux Disease Symptomatology Research Articles

Ligamentum teres cardiopexy for post vertical sleeve gastrectomy gastroesophageal reflux.

Vertical sleeve gastrectomy (VSG) evolved in the early 2000s into the standalone weight loss procedure we see today. While numerous studies highlight VSG's durability for weight loss, and improvements co-morbidities such as type 2 diabetes mellitus and cardiovascular disease, patients with gastroesophageal reflux disease (GERD) have been counseled against VSG due to the concern for worsening reflux symptoms. When considering anti-reflux procedures, VSG patients are unable to undergo traditional fundoplication due to lack of gastric cardia redundancy. Magnetic sphincter augmentation lacks long-term safety data and endoscopic approaches have undetermined longitudinal benefits. Until recently, the only option for patients with a history of VSG with medically refractory GERD has been conversion to roux en Y gastric bypass (RNYGB), however, this poses other risks including marginal ulcers, internal hernias, hypoglycemia, dumping syndrome, and nutritional deficiencies. Given the risks associated with conversion to RNYGB, we have adopted the ligamentum teres cardiopexy as an option for patients with intractable GERD following VSG. A retrospective chart review was conducted of patients who had prior laparoscopicor robotic VSG and subsequently GERD symptoms refectory to pharmacological management who underwent ligamentum teres cardiopexy between 2017 and 2022. Pre-operative GERD disease burden, intraoperative cardiopexy characteristics, post-operative GERD symptomatology and changes in H2 blocker or PPI requirements were reviewed. Of the study's 60 patients the median age was 50years old, and 86% were female. All patients had a diagnosis of GERD through pre-operative assessments and were taking antisecretory medication. Of the 36 patients who have completed their one year follow up, 81% of patients had either a decrease in dosage or cessation of the antisecretory medication at one year following ligamentum teres cardiopexy. Ligamentum teres cardiopexy is a viable alternative to RNYGB in patients with a prior vertical sleeve gastrectomy with medical refractory GERD.

The Spectrum of Treatment Modalities for Gastroesophageal Reflux Disease (GERD): A Narrative Review.

Gastroesophageal reflux disease (GERD) is a prevalent gastrointestinal disease that is encountered and treated by physicians all over the world. It is a chronic and non-progressive condition. Symptoms can range from mild heartburn to chronic, recurrent, and severe symptoms like constant acid regurgitation, laryngitis, bad breath, otitis media, and severe heartburn, which can be debilitating to the patient. Hence, the administration of appropriate therapy according to the patient's severity of symptoms is imperative, more so because over-the-counter drugs like antacids are very common to treat GERD. Often, in some instances, mere changes in lifestyle prove highly effective in reversing GERD symptomatology. Depending on the severity, response to treatment, and presence or absence of complications, treatment with medical or surgical modalities can be decided. It has now been found that although the gold standard in medical therapy for GERD has been proton pump inhibitors (PPIs), there has been increasing research about their side effects and recurrence after treatment. Hence, newer anti-GERD drugs have been under trial, which has been discussed in detail in the review. The use of surgical fundoplications has drastically decreased and is being widely replaced by incisionless laparoscopic fundoplications and newer endoluminal techniques such as the LINX device. This review aims to compile the vast spectrum of treatment modalities for GERD, ranging from more contemporary diagnostic methods, lifestyle modifications, medical therapy, and surgical and endoluminal techniques, with a particular focus on newer directions.

The Reflux and BariClip: Initial Results and Mechanism of Action.

Laparoscopic BariClip Gastroplasty (LBCG) represents a new bariatric procedure that mimics the principle of the Laparoscopic Sleeve Gastrectomy (LSG), but using a completely reversible mechanism, which is essential for gastroesophageal reflux disease (GERD). The purpose of our study was to evaluate the evolution of GERD following the initial experience with LBCG. The first 43 obese patients who underwent LBCG performed by the same surgeon in two different medical centers in May 2018-December 2019 were included in the current study. Twelve patients had issues of reflux, regularly receiving PPIs (proton pump inhibitors) treatment in eight cases, and occasionally in four cases. Thirty-two patients completed the follow-up at one year and the GERD was evaluated using the PPI medications and the GerdQ. The median preoperative GerdQ score was (14.58 ± 1.9). Three patients out of the twelve who had complained about preoperative GERD did not consent to the one year follow-up form. For the rest of nine patients, the median post-operative GerdQ score was (10.11 ± 3.2). The PPIs were used at one year follow-up in six patients: four with occasional use, one patient with regular use showing no improvement, and one who experienced de novo GERD symptomatology (3.1%). No statistically significant difference between the groups was recorded in terms of GERD. We recorded no intraoperative complications. No case of erosion occurred in the post-operative period, but we encountered two cases of slippage. One additional BariClip was removed at 14 months. LBCG represents a new bariatric procedure that mimics the principle of the laparoscopic sleeve gastrectomy, but with a completely reversible mechanism. Even with limited cases, our experience reports several mechanisms of action that will be evaluated and discussed in further prospective clinical trials. After this preliminary clinical study, LBCG's effects on GERD and its safety are highly encouraging.

Validation of the Reflux Disease Questionnaire for a Turkish Population.

Achieving the correct diagnosis and therapeutic success in gastroesophageal reflux disease (GERD) depends on the patient's self-assessment. Therefore, valid and reliable patient-reported questionnaires are very important. When designing such measurement tools, researchers should focus on their validity, reliability, sensitivity, and, applicability. The reflux disease questionnaire (RDQ) largely meets these important requirements. This study aims to examine The RDQ's psychometric characteristics for the Turkish society (RDQ TR ) and its validity in symptoms' evaluation. The sample of this study comprised 81 patients who were admitted to our institution, GERD study group outpatient clinic. The data collection forms used in the study were the case report forms and RDQ. Three weeks after the first interview, 30 patients were re-interviewed by the phone and the RDQ was re-administered. For the validity studies of the scale, language validity, content validity, and construct validity studies were used, and for the reliability studies, internal consistency and test-retest reliability methods were used. The content validity index of form was 0.95 (0.93-0.98). The performed factor analysis indicated 3 factors with an eigenvalue over 1.0. Those factors were responsible for 77.66% of the variance. The Cronbach's alpha values were 0.88 for regurgitation sub-dimension, 0.91 for dyspepsia sub-dimension, 0.86 for heartburn sub-dimension, and 0.92 overall. Intraclass correlation coefficient value of the scale was 0.94. Our study highlights that the RDQ TR is reliable, valid, and responsive to change in Turkey patients with GERD symptomatology.

Endoscopic Findings 5Years Following Sleeve Gastrectomy.

Laparoscopic sleeve gastrectomy (LSG) has rapidly become increasingly popular in bariatric surgery. However, in the long-term follow-up, intractable severe gastroesophageal reflux disease (GERD) after primary LSG can necessitate further investigations. The purpose of this study was to evaluate the endoscopic results at 5-year follow-up, on a cohort of patients who underwent LSG, the correlation GERD-esophagitis, and the results of pH-metry studies. Forty-eight patients that underwent LSG (same surgeon) in our center between 2010 and 2015 were included. These patients were identified during the regular annual follow-up visit between January and July 2018 and systematic upper endoscopy was proposed. A pH-metry was carried out for the 13 patients who presented QoL altering GERD symptoms. Twenty-two patients (45.8%) with abnormal endoscopic results were identified at a mean follow-up of 62.4months following LSG. GERD symptomatology was identified for only 13 patients (27.1%) during the follow-up compared to 18 patients (37.5%) preoperatively. Esophageal pH-metry was performed for 13 patients (27.1%). Ten patients (20.8%) (one with esophagitis and nine with QoL altering GERD) had a pathological reflux with a DeMeester score of 47 ± 8 (30-70 interval). The other three patients had normal lower than 20 DeMeester scores. GERD symptomatology was related to weight loss failure for four patients. Fourteen patients (29.2%) in our series benefited from redo surgery, with subsequent RYGB conversion (four with BE, one with severe esophagitis, and nine with persistent QoL altering GERD symptomatology). One patient has been reoperated on at day 1 postoperatively for hemorrhage from jejuno-jejunal anastomosis. Mean hospital stay of 1.92days. Our study identified an important number of asymptomatic patients with different modifications on upper endoscopy. In case of discordance between endoscopic findings and clinical presentation, additional investigation tools like pH-impedancemetry should be used. Equally, the latter should be used in case of decision to conversion for patients with severe reflux to RYGBP in order to objectify the operative indication and to achieve a reference point for follow-up.

The impact of laparoscopic anti-reflux surgery on quality of life: do patients with atypical symptoms benefit?

Gastroesophageal reflux disease (GERD) may manifest atypically as cough, hoarseness or difficulty breathing. However, it is difficult to diagnostically establish a cause-and-effect between atypical symptoms and GERD. In addition, the benefit of laparoscopic anti-reflux surgery (LARS) in patients with laryngopharyngeal manifestations of GERD are not well characterized. We report the largest series reported to date assessing operative and quality of life (QOL) outcomes after LARS in patients experiencing extraesophageal manifestations of GERD and discuss recommendations for this patient population. A retrospective review of patients with extraesophageal symptoms and pathologic reflux that underwent LARS between February 2012 and July 2019 was conducted. Inclusion criteria consisted of patients with atypical manifestations of GERD as defined by preoperative survey in addition to physiological diagnosis of pathological reflux. Patient QOL outcomes was analyzed using four validated instruments: the Reflux Symptom Index (RSI), Laryngopharyngeal Reflux QOL, Swallowing QOL (SWAL), and Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQOL) surveys. 420 patients (24% male, 76% female) with a mean age of 61.7 ± 13.0years and BMI of 28.6 ± 5.0kg/m2 were included in this study. Thirty-day wound (0.2%) and non-wound (6.74%) related complication rates were recorded in addition to thirty-day readmission rate (2.6%). Patients reported significant improvements in laryngopharyngeal symptoms at mean follow-up of 18.9 ± 16.6months post LARS reflected by results of four QOL instruments (RSI -64%, LPR -75%, GERD-HRQOL -80%, SWAL + 18%). The majority of patients demonstrated complete resolution of symptoms upon subsequent encounters with 68% of patients reporting no atypical extraesophageal manifestations during follow-up survey (difficulty breathing -86%, chronic cough -81%, hoarseness -66%, globus sensation -68%) and 68% of patients no longer taking anti-reflux medication. Seventy-two percent of patients reported being satisfied with their symptom control at latest follow-up. In appropriately selected candidates with atypical GERD symptomatology and objective diagnosis of GERD LARS may afford significant QOL improvements with minimal operative or long-term morbidity.

Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass in patients with gastroesophageal reflux disease: results of a multicenter study.

The main side effect of long-term laparoscopic sleeve gastrectomy is the onset of severe gastroesophageal reflux disease (GERD). The aim of this study was to evaluate the effectiveness of gastric bypass conversion in controlling postsleeve GERD. University Hospital and Private Hospital, France and Private Hospital, Italy. This retrospective multicenter study included patients who underwent laparoscopic sleeve gastrectomy and suffered from postoperative GERD, who did not respond to medicaltreatment and were converted to laparoscopic Roux-en-Y gastric bypass. The studyinvolved 2 French university hospitals, 4 French private centers, and an Italian public hospital. A total of 80 patients were reviewed. Treatment of a hiatal hernia was performed during laparoscopic sleeve gastrectomy in 3 patients, while 19 patients were operated for hiatal hernia during conversion to bypass (P = .0004). Six months after surgery, 23 of 80 patients maintained reflux symptomatology with a daily frequency, for which continued proton pumpinhibitor treatment was required. The persistence of GERD was significantly more frequent among patients with previous gastric banding (n = 19) compared with patients with no history of gastric banding (n = 4, P = .02). In other words, the likelihood of having poor clinical success from conversion of the sleeve to bypass because of intractable GERD was 3 times higher if the patient had a history of gastric banding (relative risk = 2.89, odds ratio =3.69). The results of this study show that, despite the conversion, the symptomatology of GERD does not always disappear, especially in patients with previous gastric banding.

Evaluation of GERD Diagnosis, Management, and Outcomes

Background: Gastroesophageal Reflux Disease (GERD) is a condition which develops when the reflux of gastric content causes troublesome symptoms or complications. GERD is arguably the most common disease encountered by the gastroenterologist. It is equally likely that the primary care providers will find that complaints related to reflux disease constitute a large proportion of their practice.(1) GERD condition can present with different presentations and the response to the intervention significantly differs from patient to patient. As a result reviewing the new literatures done in this field will help in providing a better outcomes for the patients. Objective: Treating patients with GERD is difficult and needs different approaches. In this paper, we reviewed the major and the latest studies regarding GERD symptomatology, risk factors, diagnosis and management. Method: A comprehensive search was done using biomedical databases; Medline, and PubMed, for studies concerned with assessment of GERD. Keywords used in our search through the databases were as; “GERD Pathophysiology”, “GERD Classification”, and “GERD Management”. Conclusion: GERD is a condition which develops when the reflux of gastric content causes troublesome symptoms such as heartburn, regurgitation, and sleep disturbance. GERD can be diagnosed by various measures such as GERD Questionnaire, PH Monitoring, and Upper Endoscopy. Initially GERD can be managed by simple life modification measures, then physicians can add Protons Pump Inhibitors (PPIs), and Histamine 2 Receptor Blocker (H2RBs). In case of PPIs and H2RBs failure in reliving GERD symptoms physicians may go for anti-reflux surgical interventions.

Evaluation of GERD Diagnosis, Management, and Outcomes

Background: Gastroesophageal Reflux Disease (GERD) is a condition which develops when the reflux of gastric content causes troublesome symptoms or complications. GERD is arguably the most common disease encountered by the gastroenterologist. It is equally likely that the primary care providers will find that complaints related to reflux disease constitute a large proportion of their practice.(1) GERD condition can present with different presentations and the response to the intervention significantly differs from patient to patient. As a result reviewing the new literatures done in this field will help in providing a better outcomes for the patients. Objective: Treating patients with GERD is difficult and needs different approaches. In this paper, we reviewed the major and the latest studies regarding GERD symptomatology, risk factors, diagnosis and management. Method: A comprehensive search was done using biomedical databases; Medline, and PubMed, for studies concerned with assessment of GERD. Keywords used in our search through the databases were as; “GERD Pathophysiology”, “GERD Classification”, and “GERD Management”. Conclusion: GERD is a condition which develops when the reflux of gastric content causes troublesome symptoms such as heartburn, regurgitation, and sleep disturbance. GERD can be diagnosed by various measures such as GERD Questionnaire, PH Monitoring, and Upper Endoscopy. Initially GERD can be managed by simple life modification measures, then physicians can add Protons Pump Inhibitors (PPIs), and Histamine 2 Receptor Blocker (H2RBs). In case of PPIs and H2RBs failure in reliving GERD symptoms physicians may go for anti-reflux surgical interventions.

Helicobacter pylori detection and clinical symptomatology of gastroesophageal reflux disease in pediatric patients with otitis media with effusion

ObjectivesThe study aimed to demonstrate Helicobacter pylori presence in otitis media with effusion (OME) and its association with symptomatology of gastroesophageal reflux disease (GERD). MethodsIn a cohort study, 69 effusions were collected during tympanostomy tube insertion for H. pylori detection using PCR and ELISA. Validated questionnaires were performed according to age for clinical diagnosis of GERD; chi-square ×2 statistical analysis was made. ResultsEight of the 69 ear effusions (5.7%) were positive for H. pylori detection using ELISA. Two patients (2.9%) had positive results for H. pylori detection using ELISA and PCR. These eight patients had positive results too in GERD questionnaires. None of the patients with negative/suspect questionnaires had positive results for H. pylori. We found statistical association between the results of ELISA, PCR and questionnaires (×2, p = 0.001). ConclusionsThe H. pylori presence in effusions varies widely, in our population the frequency was lower than other reports. We found strong association between H. pylori in effusions and positive GERD questionnaires. The bacterium role in OME chronicity is not clear, but this study supports the GERD participation in OME pathogenesis.

The effect of bariatric surgery on gastroesophageal reflux disease

Obesity is an epidemic that is known to play a role in the development of gastroesophageal reflux disease (GERD). Studies have shown that increasing body mass index plays a role in the incompetence of the gastroesophageal junction and that weight loss and lifestyle modifications reduce the symptoms of GERD. As a method of producing effective and sustainable weight loss, bariatric surgery plays a major role in the treatment of obesity. We reviewed the literature on the effects of different types of bariatric surgery on the symptomatic relief of GERD and its complications. Roux-en- Y gastric bypass was considered an effective method to alleviate symptoms of GERD, whereas laparoscopic sleeve gastrectomy appeared to increase the incidence of the disease. Adjustable gastric banding was seen to initially improve the symptoms of GERD; however, a subset of patients experienced a new onset of GERD symptoms during long-term follow-up. The literature suggests that different surgeries have different impacts on the symptomatology of GERD and that careful assessment may be needed before performing bariatric surgery in patients with GERD.

Association of Esophageal Inflammation, Obesity and Gastroesophageal Reflux Disease: From FDG PET/CT Perspective

ObjectiveGastroesophageal reflux disease (GERD) is associated with bothersome symptoms and neoplastic progression into Barrett's esophagus and esophageal adenocarcinoma. We aim to determine the correlation between GERD, esophageal inflammation and obesity with 18F-Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT).MethodsWe studied 458 subjects who underwent a comprehensive health check-up, which included an upper gastrointestinal endoscopy, FDG PET/CT and complete anthropometric measures. GERD symptoms were evaluated with Reflux Disease Questionnaire. Endoscopically erosive esophagitis was scored using the Los Angeles classification system. Inflammatory activity, represented by standardized uptake values (SUVmax) of FDG at pre-determined locations of esophagus, stomach and duodenum, were compared. Association between erosive esophagitis, FDG activity and anthropometric evaluation, including body mass index (BMI), waist circumference, visceral and subcutaneous adipose tissue volumes were analyzed.ResultsSubjects with erosive esophagitis (n = 178, 38.9%) had significantly higher SUVmax at middle esophagus (2.69±0.74 vs. 2.41±0.57, P<.001) and esophagogastric junction (3.10±0.89 vs. 2.38±0.57, P<.001), marginally higher at upper esophageal sphincter (2.29±0.42 vs. 2.21±0.48, P = .062), but not in stomach or duodenum. The severity of erosive esophagitis correlated with SUVmax and subjects with Barrett's esophagus had the highest SUVmax at middle esophagus and esophagogastric junction. Heartburn positively correlated with higher SUVmax at middle oesophagus (r = .262, P = .003). Using multivariate regression analyses, age (P = .027), total cholesterol level (P = .003), alcohol drinking (P = .03), subcutaneous adipose tissue (P<.001), BMI (P<.001) and waist circumference (P<.001) were independently associated with higher SUVmax at respective esophageal locations.ConclusionsEsophageal inflammation demonstrated by FDG PET/CT correlates with endoscopic findings and symptomatology of GERD. Obesity markers, both visceral and general, are independent determinants of esophageal inflammation.

Laparoscopic antireflux procedures with hepatic shoulder technique for the surgical management of large paraesophageal hernias and gastroesophageal reflux disease

Large paraesophageal hernias are notoriously difficult to manage via laparoscopy and are associated with a significant recurrence rate. A novel laparoscopic approach was used to close the diaphragmatic defect in four patients diagnosed with large, paraesophageal hernias and gastroesophageal reflux disease symptomatology. All procedures were performed via laparoscopy. Three patients underwent a reduction of the paraesophageal hernia with a Nissen fundoplication and one with Collis-Nissen fundoplication. Standard crural closure was performed over a #60 Fr Bougie in two patients, and two patients did not undergo a cruroplasty. In all four patients, the left hepatic lobe was freed, repositioned, and anchored under and inferior to the gastroesophageal junction, propping the gastroesophageal junction anteriorly. This maneuver entirely covers and closes the diaphragmatic defect. Postoperatively, all patients did well without notable, unusual complaints. Average length of stay was 2 days. Although not statistically significant, all patients had no recurrence of symptoms or of their paraesophageal hernia at 8, 9, 11, and 15 months after the procedure. In selected patients, large paraesophageal hernias can safely be managed via a laparoscopic antireflux procedure with the hepatic shoulder technique. Although no long-term follow-up is available, this technique has shown good early postoperative results and may be used as an alternative to a laparoscopic Mesh reinforced fundoplication or difficult crural closure.

Pantoprazole 40 mg Is as Effective as Esomeprazole 40 mg to Relieve Symptoms of Gastroesophageal Reflux Disease after 4 Weeks of Treatment and Superior regarding the Prevention of Symptomatic Relapse

Background/Aim: Little is known about the symptom course during and after treatment of gastroesophageal reflux disease (GERD). Here we address this question in patients with erosive GERD treated with pantoprazole or esomeprazole 40 mg once daily using the validated reflux questionnaire ReQuest^TM. Methods: Of 585 patients enrolled, 561 (intention-to-treat; ITT) patients with endoscopically confirmed GERD grades A–D (Los Angeles Classification) were randomized. To assess the GERD symptomatology, the patients completed the ReQuest daily, and analysis was done prior to (7 days), during (28 days), and after treatment (7 days). The mean scores (last 3 treatment days) of the subscale ReQuest^TM-GI (gastrointestinal complaints) were compared between both groups. After the end of treatment, the number of symptom episodes and the rate of relapses were calculated. Results: Noninferiority of pantoprazole versus esomeprazole during treatment was shown (mean ReQuest-GI score). During the posttreatment period, the proportion of patients experiencing a symptomatic relapse (51 vs. 61%, p = 0.0216, ITT) and the number of symptom episodes (0.56 vs. 0.74, p = 0.0095, ITT) were significantly lower on pantoprazole than on esomeprazole. Conclusions: Pantoprazole 40 mg was at least as effective as esomeprazole 40 mg for relieving GERD symptoms. During the posttreatment phase, patients on pantoprazole had a significantly lower risk to relapse and experienced significantly fewer symptom episodes.

Pantoprazole 40 mg Is as Effective as Esomeprazole 40 mg to Relieve Symptoms of Gastroesophageal Reflux Disease after 4 Weeks of Treatment and Superior regarding the Prevention of Symptomatic Relapse

Background/Aim: Little is known about the symptom course during and after treatment of gastroesophageal reflux disease (GERD). Here we address this question in patients with erosive GERD treated with pantoprazole or esomeprazole 40 mg once daily using the validated reflux questionnaire ReQuest^TM. Methods: Of 585 patients enrolled, 561 (intention-to-treat; ITT) patients with endoscopically confirmed GERD grades A–D (Los Angeles Classification) were randomized. To assess the GERD symptomatology, the patients completed the ReQuest daily, and analysis was done prior to (7 days), during (28 days), and after treatment (7 days). The mean scores (last 3 treatment days) of the subscale ReQuest^TM-GI (gastrointestinal complaints) were compared between both groups. After the end of treatment, the number of symptom episodes and the rate of relapses were calculated. Results: Noninferiority of pantoprazole versus esomeprazole during treatment was shown (mean ReQuest-GI score). During the posttreatment period, the proportion of patients experiencing a symptomatic relapse (51 vs. 61%, p = 0.0216, ITT) and the number of symptom episodes (0.56 vs. 0.74, p = 0.0095, ITT) were significantly lower on pantoprazole than on esomeprazole. Conclusions: Pantoprazole 40 mg was at least as effective as esomeprazole 40 mg for relieving GERD symptoms. During the posttreatment phase, patients on pantoprazole had a significantly lower risk to relapse and experienced significantly fewer symptom episodes.

GERD Evaluation

In the past there has been reliance on heartburn and acid regurgitation as the cardinal symptoms of gastro-esophageal reflux. Now it is recognized that diverse additional symptoms including extraesophageal manifestations are essential components of gastroesophageal reflux disease (GERD). Furthermore, previous reliance in mucosal damage at endoscopy as evidence of therapeutic success in the management of GERD has proven of only limited value in the diverse world of GERD symptoms. Indeed is now apparent that the relationship between symptoms and lesions is modest at best. Most patients with GERD have no overt erosions or ulceration at endoscopy and they frequently suffer from a wide array of complaints other than heartburn that contribute to their diminished perception of life's quality. To address these problems, multidimensional questionnaires designed to encompass the diverse symptomatology of GERD have been investigated, principally, to provide a reproducible metric of change in the subjective response to pharmacologic therapy during trials for patients with nonerosive reflux disease. The most promising of these instruments is The ReQuest questionnaire, because it has been extensively validated in multiple patient groups and cultures, appears highly promising in this regard and for erosive disease too and may ultimately prove to be of value for the initial evaluation of patients with GERD. We propose that accurate symptom delineation complemented with endoscopy performed in selected groups of patients will become the mainstay in diagnosis of GERD and the assessment of therapy efficacy.

Refractory heartburn

Refractory heartburn

Gastroesophageal reflux laryngitis resistant to omeprazole therapy

Gastroesophageal reflux disease (GERD) is known to cause a variety of symptoms that lead a patient to seek otolaryngologic care. New advances in the treatment of GERD have enabled otolaryngologists to eliminate most of the signs and symptoms caused by acid reflux. Omeprazole, the most recent pharmacologic advancement, has been reported to be universally successful in controlling acid release from the stomach of patients with GERD. This report describes a series of patients with GERD for whom high-dose omeprazole therapy was not successful in completely reducing gastric acid levels of GERD symptomatology.