Optimal management of severe symptomatic gastroesophageal reflux disease.

Journal of Internal Medicine
Nicholas J Talley, M Zand Irani

Abstract

Gastroesophageal reflux disease (GERD) is a common disorder, and empirical proton pump inhibitor (PPI) treatment is often the first step of management; however, up to 40% of patients remain symptomatic despite PPI treatment. Refractory reflux refers to continued symptoms despite an adequate trial of PPI, and management remains challenging. The differential diagnosis is important; other oesophageal (e.g. eosinophilic oesophagitis) and gastroduodenal disorders (e.g. functional dyspepsia) should be ruled out, as this changes management. A combination of clinical assessment, endoscopic evaluation and in selected cases oesophageal function testing can help characterize patients with refractory reflux symptoms into oesophageal phenotypes so appropriate therapy can be more optimally targeted. Medical options then may include adding a H2 receptor antagonist, alginates, baclofen or antidepressant therapy, and there is emerging evidence for bile acid sequestrants and diaphragmatic breathing. The demonstration of a temporal association of symptoms with reflux events on pH-impedance testing (reflux hypersensitivity) serves to focus the management on modulating oesophageal perception and reducing the reflux burden, or identifies those with ...Continue Reading

References

May 1, 1988·Digestive Diseases and Sciences·J W HamiltonM Reichelderfer
Mar 18, 1999·The New England Journal of Medicine·J LagergrenO Nyrén
Jan 15, 2004·The American Journal of the Medical Sciences·Daniel C BucklesRichard W McCallum
Nov 4, 2004·Alimentary Pharmacology & Therapeutics·S Rodriguez-StanleyP B Miner
Jun 30, 2005·The American Journal of Gastroenterology·Sanjay NandurkarNicholas J Talley
Jan 25, 2006·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Ronnie FassMark Sostek
Apr 18, 2006·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Sheila Rodriguez-StanleyPhilip B Miner
Aug 25, 2006·The American Journal of Gastroenterology·Nimish VakilUNKNOWN Global Consensus Group
Nov 9, 2006·The American Journal of Gastroenterology·Denesh K ChitkaraNicholas J Talley
Jun 19, 2007·The American Journal of Gastroenterology·Michael PiesmanRoy K H Wong
Sep 14, 2007·The American Journal of Gastroenterology·Giuseppe ScarpullaMark Fox
Sep 19, 2007·Alimentary Pharmacology & Therapeutics·R DickmanR Fass
Sep 29, 2007·The American Journal of Gastroenterology·Nicholas J TalleyL Joseph Melton
Jul 12, 2008·The American Journal of Gastroenterology·Nimish VakilMarielle Cohard-Radice
Mar 8, 2011·Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver·Edoardo SavarinoVincenzo Savarino
Mar 23, 2011·Surgical Endoscopy·Walter W ChanC Prakash Gyawali
Apr 27, 2011·The American Journal of Gastroenterology·Nimish B VakilDavid Stamler
May 4, 2011·The American Journal of Gastroenterology·Peter J KahrilasNesta Hughes
May 19, 2011·JAMA : the Journal of the American Medical Association·Jean-Paul GalmicheUNKNOWN LOTUS Trial Collaborators
Jul 26, 2011·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·James C SlaughterMichael F Vaezi
Dec 8, 2011·The American Journal of Gastroenterology·A J EhererKarl Martin Hoffmann
May 15, 2013·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Wout O RohofGuy E Boeckxstaens
Nov 6, 2013·Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society·C M ForceliniF Fornari
Dec 7, 2013·Journal of Gastroenterology and Hepatology·Marjorie M WalkerNicholas J Talley
Dec 11, 2013·The American Journal of Gastroenterology·Eivind Ness-JensenKristian Hveem
Feb 19, 2014·Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society·M R OstovanehS A Mirbagheri
Mar 8, 2014·World Journal of Gastroenterology : WJG·Li-Hua RenRui-Hua Shi
May 29, 2014·World Journal of Gastrointestinal Pharmacology and Therapeutics·Johnson W McRoriePhilip B Miner
Jun 12, 2014·Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society·C PleyerN J Talley

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Citations

Oct 1, 2021·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Milena NikolicSebastian F Schoppmann

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