Treatment Strategy for Standard-Dose Proton Pump Inhibitor-Resistant Reflux Esophagitis

Iwakiri, Katsuhiko

doi:10.1272/jnms.84.209

Cited by 7 publications

(6 citation statements)

References 33 publications

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“…The clinical practice guidelines for gastroesophageal reflux disease (GERD) established by the Japanese Society of Gastroenterology recommend proton pump inhibitors (PPI) as the first-line drug for its treatment [1]; however, the efficacy rate of PPI is approximately 50% in non-erosive reflux disease (NERD) patients [2] due to the multifactorial pathophysiology of NERD in contrast to reflux esophagitis caused by excessive esophageal acid exposure [3, 4]. Various mechanisms have been suggested to explain the failure of PPI in patients with NERD, with relevant factors being acid reflux due to insufficient acid suppression despite receiving PPI, non-acid and gas reflux with visceral hypersensitivity, esophageal motility disorders, eosinophilic esophagitis (EoE), and psychological factors [5].…”

Section: Introductionmentioning

confidence: 99%

Pathogenesis of Potassium-Competitive Acid Blocker-Resistant Non-Erosive Reflux Disease

Kawami¹,

Hoshino²,

Hoshikawa³

et al. 2018

Digestion

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Background: The present study examined the pathogenesis of potassium-competitive acid blocker (P-CAB)-resistant non-erosive reflux disease (NERD). Methods: Forty-three patients with NERD, who had persistent reflux symptoms despite the administration of P-CAB, were included in this study. After excluding eosinophilic esophagitis and primary esophageal motility disorders, esophageal impedance-pH monitoring was performed. In symptom index (SI)-positive patients, the mechanism of SI-positivity and percent time with intragastric pH > 4 and with esophageal pH < 4 were investigated according to the presence or absence of Helicobacter pylori infection. Results: One (2.3%) of 43 patients had a primary esophageal motility disorder (Jackhammer esophagus). Eighteen (41.9%) and 3 (7%) patients were SI-positive for liquid and gas-only reflux, respectively, and the remaining 21 patients who were SI-negative (48.8%) had functional heartburn. All patients SI-positive for liquid reflux were SI-positive for weakly acidic reflux. Gastric acid was sufficiently suppressed by P-CAB, regardless of the presence or absence of H. pylori infection. Conclusions: The pathogenesis of P-CAB-resistant NERD was elucidated in 51% of patients. Symptoms in all patients SI-positive for liquid reflux were related to weakly acidic reflux, and symptoms related to acid reflux may be ruled out by the administration of P-CAB.

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Section: Introductionmentioning

confidence: 99%

Pathogenesis of Potassium-Competitive Acid Blocker-Resistant Non-Erosive Reflux Disease

Kawami¹,

Hoshino²,

Hoshikawa³

et al. 2018

Digestion

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“…Standard PPI therapy is effective in 90%–100% of people with mild symptoms; however, effectiveness decreases to ~60% in people with the most severe disease. 38 Evidence indicates that for maintenance therapy, low-dose PPI is as effective as high dose. 54 But patients being treated with PPIs for severe erosive esophagitis, or disease resistant to standard PPI doses, experience better healing with once daily double doses of PPI (eg, 40 mg esomeprazole versus 20 mg), or twice daily split dosing (eg esomeprazole 20 mg twice daily).…”

Section: Gerd Treatmentmentioning

confidence: 99%

“…More recently, evidence indicates that a split dosing PPI regimen is superior to once daily double dosing, as it provides a bimodal distribution of plasma PPI concentration, which enables better inhibition of existing proton pumps over 24 hours and inhibition of newly produced pumps. 38 PPI-resistant disease may also be improved by changing administration of the PPI to 1 hour before the largest meal of the day (usually dinner), to match the peak plasma concentration of the PPI (2–3 hours after oral administration), with the greatest expression of the proton pump. 38 Trialing a different PPI in resistant disease may also be beneficial.…”

Section: Gerd Treatmentmentioning

confidence: 99%

“… 38 PPI-resistant disease may also be improved by changing administration of the PPI to 1 hour before the largest meal of the day (usually dinner), to match the peak plasma concentration of the PPI (2–3 hours after oral administration), with the greatest expression of the proton pump. 38 Trialing a different PPI in resistant disease may also be beneficial. 38 The American Food and Drug Administration has approved all PPIs listed in Table 4 for the healing and maintenance of ERD and for NERD, except pantoprazole, which is not approved for NERD.…”

Section: Gerd Treatmentmentioning

confidence: 99%

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Management of gastroesophageal reflux disease in adults: a pharmacist’s perspective

MacFarlane¹

2018

IPRP

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Gastroesophageal reflux disease (GERD) is a common gastrointestinal diagnosis, a leading reason for endoscopy and cause of potentially serious complications, resulting in significant individual and system-wide health burden. Approximately one quarter of people living in western countries have experienced GERD, and the prevalence appears to be on the rise. Risk factors for GERD include hiatus hernia, obesity, high-fat diet, tobacco smoking, alcohol consumption, pregnancy, genetics, and some medications. The cardinal symptoms of GERD are troublesome heartburn and regurgitation. GERD is identified by taking a patient-centered history and if necessary can be classified by endoscopic investigation. The role of the pharmacist in the management of GERD is to confirm the diagnosis by history taking, confirm there are no alarming signs or symptoms that require referral to a doctor, and recommendation of short-term therapy to control symptoms. Effective pharmacological treatments for GERD include antacids, alginate, histamine H2 receptor antagonists, and proton pump inhibitors. This narrative review includes a comparison of the efficacy and safety of these treatments and pertinent information to help pharmacists advise patients with GERD on their appropriate use.

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“…Achalasia, a primary esophageal motility disorder, is characterized by disappearance of peristalsis in the esophageal body and incomplete relaxation of the lower esophageal sphincter (LES). Esophageal manometry is indispensable for diagnosing esophageal motility disorders such as achalasia and is also used for evaluation of the pathophysiology of gastroesophageal reflux disease 1,2 . The recent development of a high-resolution manometry (HRM) system with 36 channels spaced at 1-cm intervals has enabled detailed evaluation of esophageal motility function.…”

Section: Introductionmentioning

confidence: 99%

Validity of the Cutoff Value for Integrated Relaxation Pressure Used in the Starlet High-Resolution Manometry System

et al. 2019

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Background: In a previous study that used the Starlet high-resolution manometry system to assess integrated relaxation pressure (IRP) in healthy adults, the predicted cutoff value was about 26 mm Hg. However, some patients with achalasia have an IRP value of <26 mm Hg. This study examined the validity of the Starlet IRP cutoff value in patients with achalasia. Methods: Among 37 patients with achalasia, the percentage of patients with a Starlet IRP value ! 26 mm Hg was calculated. Patients were then classified as IRP-high (IRP ! 26 mm Hg) and IRP-low (IRP <26 mm Hg), and the groups were compared in relation to basal lower esophageal sphincter (LES) pressure, Chicago classification achalasia subtype, and esophagography subtype. Results: Twenty (54%) of the 37 patients had an IRP of ! 26 mm Hg. Basal LES pressure was significantly higher in the IRP-high group than in the IRP-low group. Chicago classification Type II achalasia was most common in the IRP-high group, whereas Type I was most common in the IRP-low group. No significant difference was noted in the distribution of esophagography subtypes between groups. Conclusions: It is difficult to determine an IRP cutoff value with Starlet. When diagnosing achalasia with Starlet, comprehensive assessment must consider findings other than IRP values. In addition, IRP was associated with Chicago classification type.

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Treatment Strategy for Standard-Dose Proton Pump Inhibitor-Resistant Reflux Esophagitis

Cited by 7 publications

References 33 publications

Pathogenesis of Potassium-Competitive Acid Blocker-Resistant Non-Erosive Reflux Disease

Pathogenesis of Potassium-Competitive Acid Blocker-Resistant Non-Erosive Reflux Disease

Management of gastroesophageal reflux disease in adults: a pharmacist’s perspective

Validity of the Cutoff Value for Integrated Relaxation Pressure Used in the Starlet High-Resolution Manometry System

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Treatment Strategy for Standard-Dose Proton Pump Inhibitor-Resistant Reflux Esophagitis

Cited by 7 publications

References 33 publications

Pathogenesis of Potassium-Competitive Acid Blocker-Resistant Non-Erosive Reflux Disease

Pathogenesis of Potassium-Competitive Acid Blocker-Resistant Non-Erosive Reflux Disease

Management of gastroesophageal reflux disease in adults: a pharmacist&rsquo;s perspective

Validity of the Cutoff Value for Integrated Relaxation Pressure Used in the Starlet High-Resolution Manometry System

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Product

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Management of gastroesophageal reflux disease in adults: a pharmacist’s perspective