| How to manage refractory GERD. | |
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MedLine Citation:
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PMID: 18043675 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Joel E Richter |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Nature clinical practice. Gastroenterology & hepatology Volume: 4 ISSN: 1743-4386 ISO Abbreviation: - Publication Date: 2007 Dec |
Date Detail:
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Created Date: 2007-11-28 Completed Date: 2008-01-10 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101226510 Medline TA: Nat Clin Pract Gastroenterol Hepatol Country: England |
Other Details:
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Languages: eng Pagination: 658-64 Citation Subset: IM |
Affiliation:
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Department of Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA. jrichter@temple.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Digestive System Surgical Procedures
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methods* Endoscopy, Gastrointestinal / methods* Gastric Acidity Determination Gastroesophageal Reflux* / diagnosis, etiology, therapy Gastrointestinal Agents / therapeutic use* Humans Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Gastrointestinal Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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