The Proton Pump Inhibitor Non-Responder: A Clinical Conundrum

Hussain, Zilla; Henderson, Emily E.; Maradey-Romerao, Carla; George, Nina; Fass, Ronnie; Lacy, Brian E.

doi:10.1038/ctg.2015.45

Cited by 11 publications

(18 citation statements)

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“…Multiple elements can contribute to breakthrough symptoms, including issues with PPI compliance and dosing, persistence of reflux events (acidic, weakly acidic, bile, pepsin or gas), greater proximal extent of reflux, impaired oesophageal mucosal integrity, chemical or mechanical hypersensitivity to refluxates and psychological comorbidity . GERD patients with an unsatisfactory symptomatic response can be broadly categorised as “typical reflux” (abnormal oesophageal acid exposure, positive symptom‐reflux association), “hypersensitive” (normal acid exposure, positive symptom‐reflux association) or functional heartburn (normal acid exposure, negative symptom‐reflux association) …”

Section: Introductionmentioning

confidence: 99%

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Randomised clinical trial: addition of alginate‐antacid (Gaviscon Double Action) to proton pump inhibitor therapy in patients with breakthrough symptoms

Coyle

Crawford

Wilkinson

et al. 2017

Aliment Pharmacol Ther

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show abstract

Section: Introductionmentioning

confidence: 99%

“…Alginates are interesting candidates for use as an add‐on therapy as they act in a complementary way to PPIs by directly capping postprandial reflux . The alginate‐antacid formulation, Gaviscon Double Action (Gaviscon DA; RB, Slough, UK), has been shown to co‐localise and eliminate the acid pocket in GERD patients .…”

Section: Introductionmentioning

confidence: 99%

Randomised clinical trial: addition of alginate‐antacid (Gaviscon Double Action) to proton pump inhibitor therapy in patients with breakthrough symptoms

Coyle

Crawford

Wilkinson

et al. 2017

Aliment Pharmacol Ther

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show abstract

“…PPI is a standard therapy for GERD in the general population, including for patients with SSc. The response rate of PPI therapy in GERD in non-SSc patients was around 22-59% [29][30][31][32][33][34] . The response rate varies according to differences in definitions, population, medication, and duration of treatment.…”

Section: Discussionmentioning

confidence: 99%

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

Foocharoen

Chunlertrith

Mairiang

et al. 2020

Sci Rep

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Proton pump inhibitor (PPI) twice daily dosing is a standard therapy for gastroesophageal reflux disease (GeRD) in systemic sclerosis (SSc) but there is no data on its response rate or the predictors of ppipartial response GeRD. Aims were to determine the prevalence of ppi-partial response GeRD in SSc and to define its predictors. A prospective study was conducted in SSc patients with GERD. The patients were treated with omeprazole 20 mg bid for 4 weeks. The severity of symptom-grading by visual analogue scale (VAS) and frequency of symptoms by frequency scale for symptoms of GeRD (fSSG) were assessed at baseline and 4 weeks after treatment. PPI-partial response GERD was defined as less than 50% improvement in the VAS for severity of symptom as well as acid reflux score by FSSG after treatment. According to the sample size calculation, 243 SSc-GERD patients were enrolled; of whom 166 (68.3%) had the diffuse cutaneous SSc. PPI-partial response GERD was found in 131 SSc patients (prevalence 53.9%; 95%CI 47.4-60.3). The multivariate analysis revealed that esophageal dysphagia was an only predictor the PPI-partial response GERD (OR 1.82; 95%CI 1.01-3.29) while neither SSc subset nor severity of skin tightness were significantly associated with PPI-partial response GERD. Half of the SSc patients were ppi-partial response GeRD. esophageal dysphagia was the only predictor of ppi-partial response GeRD in SSc patients. Screening for dysphagia before starting GeRD treatment is helpful for assessment the risk of ppi refractoriness GeRD in SSc patients.

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“…However, as many as 10–40% of patients find their reflux symptoms inadequately controlled, especially at night . Poor patient compliance, reduced PPI bioavailability, weakly acidic or nonacidic reflux, nocturnal breakthrough, esophageal hypersensitivity, functional gastrointestinal disorders, and even mental disorders may all contribute to PPI failures . For those who respond to PPI therapy, long‐term treatment with PPIs not only generates a financial burden but may also produce side effects.…”

mentioning

confidence: 99%

Contribution of immunomodulators to gastroesophageal reflux disease and its complications: stromal cells, interleukin 4, and adiponectin

Chen

Shaker

et al. 2016

Annals of the New York Academy of Sciences

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Gastroesophageal reflux disease (GERD) has become the most commonly seen gastrointestinal disorder in outpatient clinics. In the United States, around 20% of the general population experience heartburn on a weekly basis. Although clinical complaints can be mild or moderate, patients with GERD may develop further complications, such as peptic strictures, Barrett's esophagus (BE), and even esophageal adenocarcinoma (EAC). Pathologically, GERD is developed as a result of chronic and enhanced exposure of the esophageal epithelium to noxious gastric refluxate. In this review article, we provide an overview of GERD, and then focus on the roles of stromal cells, interleukin 4 (IL-4), and adiponectin in GERD and BE. The importance of inflammation and immunomodulators in GERD pathogenesis is highlighted. Targeting the immunomodulators or inflammation in general may improve the therapeutic outcome of GERD, in particular, in those refractory to proton pump inhibitors.

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The Proton Pump Inhibitor Non-Responder: A Clinical Conundrum

Cited by 11 publications

References 0 publications

Randomised clinical trial: addition of alginate‐antacid (Gaviscon Double Action) to proton pump inhibitor therapy in patients with breakthrough symptoms

Randomised clinical trial: addition of alginate‐antacid (Gaviscon Double Action) to proton pump inhibitor therapy in patients with breakthrough symptoms

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

Contribution of immunomodulators to gastroesophageal reflux disease and its complications: stromal cells, interleukin 4, and adiponectin

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