Therapeutic options for refractory gastroesophageal reflux disease

Fass, Ronnie

doi:10.1111/j.1440-1746.2012.07064.x

Cited by 52 publications

(37 citation statements)

References 54 publications

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“…This raises a potential problem of the overuse of PPIs in clinical practice. Accurate distinction between FH and GERD would be helpful for appropriate management of patients and use of PPI 17-20. However, it is general opinion that patients with positive response to PPI therapy should be included in the GERD population despite their pH or pH+impedance profile.…”

Section: Discussionmentioning

confidence: 99%

Symptom Characteristics and Psychosomatic Profiles in Different Spectrum of Gastroesophageal Reflux Disease

et al. 2014

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Background/AimsGastroesophageal reflux disease (GERD) is diagnosed based on symptoms of heartburn and regurgitation but is a heterogeneous condition which can be subclassified according to endoscopy and esophageal reflux monitoring. The aim of this study was to identify differences in demographic characteristics and reflux symptom patterns among patients with various spectrum of GERD.MethodsPatients having weekly heartburn or acid regurgitation were classified into four pathophysiological subgroups according to endoscopy and pH monitoring: reflux esophagitis (RE), endoscopy-negative reflux disease with pathological reflux (PR+), hypersensitive esophagus (HE), and normal acid exposure with negative symptom association (pH-).ResultsA total of 195 patients were enrolled. The numbers of patients in the subgroups were: RE, 39.0%; PR+, 20.0%; HE, 10.3%; and pH-, 30.8%. Grossly, reflux symptom patterns and relieving/exacerbating factors did not differ between subgroups. Prevalence of extraesophageal syndrome was higher in patients with PR+ than in other groups. Overlapping functional dyspepsia was common in all groups. The SCL-90-R depression score was higher in PR+ patients than in RE patients (p<0.05).ConclusionsDemographic characteristics and reflux symptom patterns cannot differentiate pH- group from GERD subtypes. Esophageal pH monitoring could be considered for the initial evaluation of GERD in the tertiary referral setting.

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Section: Discussionmentioning

confidence: 99%

Symptom Characteristics and Psychosomatic Profiles in Different Spectrum of Gastroesophageal Reflux Disease

et al. 2014

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“…When prescribing high-dose PPI, the dose is given twice daily before breakfast and dinner to have better control of intragastric pH [45, 126]. Although new formulations of PPIs can provide more immediate, potent, or consistent acid suppression, the real efficacy of newer PPIs for refractory GERD is still limited.…”

Section: Pharmacological Options For Refractory Gerdmentioning

confidence: 99%

Current Pharmacological Management of Gastroesophageal Reflux Disease

Wang

Hsu

Wang

et al. 2013

Gastroenterology Research and Practice

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Gastroesophageal reflux disease (GERD), a common disorder with troublesome symptoms caused by reflux of gastric contents into the esophagus, has adverse impact on quality of life. A variety of medications have been used in GERD treatment, and acid suppression therapy is the mainstay of treatment for GERD. Although proton pump inhibitor is the most potent acid suppressant and provides good efficacy in esophagitis healing and symptom relief, about one-third of patients with GERD still have persistent symptoms with poor response to standard dose PPI. Antacids, alginate, histamine type-2 receptor antagonists, and prokinetic agents are usually used as add-on therapy to PPI in clinical practice. Development of novel therapeutic agents has focused on the underlying mechanisms of GERD, such as transient lower esophageal sphincter relaxation, motility disorder, mucosal protection, and esophageal hypersensitivity. Newer formulations of PPI with faster and longer duration of action and potassium-competitive acid blocker, a newer acid suppressant, have also been investigated in clinical trials. In this review, we summarize the current and developing therapeutic agents for GERD treatment.

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“…Gastric secretion inhibitors, such as proton pump inhibitors, can alleviate GERD symptoms [1]. Moreover, gastric acid reflux into the esophagus characteristically increases after eating [2], and although GERD patients sometimes complain of nausea and a loss of appetite, the acid reflux into the esophagus that causes GERD may instead be partially due to the amount and content of food.…”

Section: Introductionmentioning

confidence: 99%

Changes in Ghrelin-Related Factors in Gastroesophageal Reflux Disease in Rats

Nahata

Saegusa

Harada

et al. 2013

Gastroenterology Research and Practice

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To examine gastrointestinal hormone profiles and functional changes in gastroesophageal reflux disease (GERD), blood levels of the orexigenic hormone ghrelin were measured in rats with experimentally induced GERD. During the experiment, plasma acyl ghrelin levels in GERD rats were higher than those in sham-operated rats, although food intake was reduced in GERD rats. Although plasma levels of the appetite-suppressing hormone leptin were significantly decreased in GERD rats, no changes were observed in cholecystokinin levels. Repeated administration of rat ghrelin to GERD rats had no effect on the reduction in body weight or food intake. Therefore, these results suggest that aberrantly increased secretion of peripheral ghrelin and decreased ghrelin responsiveness may occur in GERD rats. Neuropeptide Y and agouti-related peptide mRNA expression in the hypothalamus of GERD rats was significantly increased, whereas proopiomelanocortin mRNA expression was significantly decreased compared to that in sham-operated rats. However, melanin-concentrating hormone (MCH) and prepro-orexin mRNA expression in the hypothalamus of GERD rats was similar to that in sham-operated rats. These results suggest that although GERD rats have higher plasma ghrelin levels, ghrelin signaling in GERD rats may be suppressed due to reduced MCH and/or orexin synthesis in the hypothalamus.

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Therapeutic options for refractory gastroesophageal reflux disease

Cited by 52 publications

References 54 publications

Symptom Characteristics and Psychosomatic Profiles in Different Spectrum of Gastroesophageal Reflux Disease

Symptom Characteristics and Psychosomatic Profiles in Different Spectrum of Gastroesophageal Reflux Disease

Current Pharmacological Management of Gastroesophageal Reflux Disease

Changes in Ghrelin-Related Factors in Gastroesophageal Reflux Disease in Rats

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