Review: Causes of, and therapeutic approaches for, proton pump inhibitor-resistant gastroesophageal reflux disease in Asia

Abstract

Proton pump inhibitors (PPIs) are the most widely used drugs for treatment of gastroesophageal reflux disease. However, approximately 20% of patients with reflux esophagitis and 40% of those with nonerosive reflux diseases complain of troublesome symptoms, even during treatment with PPIs. In patients with reflux esophagitis, dose escalation and co-administration with a histamine H 2 -receptor antagonist are potential approaches, since the major cause of PPI resistance is incomplete suppression of gastric acid secretion. On the other hand, for patients with nonerosive reflux disease, switching from PPIs to pain modulators is often necessary for improvement of symptoms, since 25% of patients with nonerosive reflux disease have symptoms not caused by gastroesophageal acid reflux. Therapeutic approaches for PPI-resistant patients with reflux esophagitis and nonerosive reflux diseases are considered according to pathogenesis.

Prevalence and predictors of proton pump inhibitor partial response in gastroesophageal reflux disease in systemic sclerosis: a prospective study

“…Sample size. The sample size calculation was applied by the previous prevalence of PPI resistance from the literature review in which the prevalence of SSc in the general population was 1:100,000 and the previous prevalence of PPI resistance was 20% 28 . In order to detect a difference at 95% precision and alpha error of 0.05, the sample size was 246.…”

Comparing the Effect of Psyllium Seed on Gastroesophageal Reflux Disease With Oral Omeprazole in Patients With Functional Constipation

“… 43 – 45 In a study carried out by Barrat et al in Pakistan, omeprazole was introduced as the first drug of choice for the treatment of GERD. 48 In a study conducted by Kinoshita and Ishihara, 49 the rate of response to PPI treatment after 4 weeks in patients with GERD with erosive esophagitis was about 56% and 37% in patients with nonerosive type. PPI success was increased to 90% and 75%, respectively, after 6 months of treatments.…”

LINX Magnetic Esophageal Sphincter Augmentation vs Laparoscopic Nissen Fundoplication for Gastroesophageal Reflux Disease

“…[2][3][4] The main reason for PPI resistance is due to nonacid reflux of gastric contents through an incompetent lower esophageal sphincter (LES). 5 Other causes for PPI resistance or failure can be due to esophageal dysmotility disorder, paraesophageal hernia, and erosive esophagitis. 6,7 Laparoscopic Nissen fundoplication (LNF) is the gold standard treatment for medically refractory GERD.…”