Document Detail

How to manage refractory GERD.
MedLine Citation:
PMID:  18043675     Owner:  NLM     Status:  MEDLINE    
Patients who are unresponsive to 4-8 weeks' treatment with PPIs twice daily might have so-called refractory GERD. The first investigation these patients should undergo is upper endoscopy to exclude a diagnosis of peptic ulcer disease or cancer and identify the presence of esophagitis. The presence of esophagitis in these patients is suggestive of a pill-induced injury, an autoimmune skin disease involving the esophagus, eosinophilic esophagitis or, less likely, a hypersecretory syndrome or a genotype that confers altered metabolism of PPIs. Refractory reflux syndromes associated with normal endoscopy findings are more problematic to diagnose and further testing may be required, including prolonged 48 h pH testing, impedance measurements (for nonacid reflux), esophageal manometry and gastric function tests. For patients with refractory GERD who do not have esophagitis, possible etiologies include nocturnal gastric acid breakthrough, nonacid GER, missed GER or other diseases such as achalasia, gastroparesis or functional heartburn.
Joel E Richter
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Nature clinical practice. Gastroenterology & hepatology     Volume:  4     ISSN:  1743-4386     ISO Abbreviation:  -     Publication Date:  2007 Dec 
Date Detail:
Created Date:  2007-11-28     Completed Date:  2008-01-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101226510     Medline TA:  Nat Clin Pract Gastroenterol Hepatol     Country:  England    
Other Details:
Languages:  eng     Pagination:  658-64     Citation Subset:  IM    
Department of Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA.
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MeSH Terms
Digestive System Surgical Procedures / methods*
Endoscopy, Gastrointestinal / methods*
Gastric Acidity Determination
Gastroesophageal Reflux* / diagnosis,  etiology,  therapy
Gastrointestinal Agents / therapeutic use*
Treatment Outcome
Reg. No./Substance:
0/Gastrointestinal Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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