| Theme |
Recent Advances in Diagnosis and Treatment of Reflux Esophagitis |
| Title |
Therapeutic Approach for Patients with Severe Reflux Esophagitis |
| Author |
Kyoichi Adachi |
Department of Gastroenterology and Hepatology, Shimane University School of Medicine |
| Author |
Kenji Furuta |
Department of Gastroenterology and Hepatology, Shimane University School of Medicine |
| Author |
Masaharu Miki |
Department of Gastroenterology and Hepatology, Shimane University School of Medicine |
| Author |
Takane Azumi |
Department of Gastroenterology and Hepatology, Shimane University School of Medicine |
| Author |
Yoshikazu Kinoshita |
Department of Gastroenterology and Hepatology, Shimane University School of Medicine |
| [ Summary ] |
Two reasons why the patients with reflux esophagitis are refractory to proton pump inhibitor (PPI) therapy are thought to be low plasma concentrations of PPI after administration of the drugs and nocturnal gastric acid breakthrough (NAB). Delayed gastric emptying causes low plasma concentrations of PPI. In addition, the polymorphism of CYP2C19, which plays important roles in the metabolism of PPI, influences the plasma concentration of PPI. NAB indicates nocturnal gastric acid secretion during PPI administration, and a characteristic of subjects with NAB is negative of Helicobacter pylori infection. Since nocturnal gastro-esophageal reflux is frequently observed in patients with high grade reflux esophagitis, the existence of NAB should be considered when patients with high grade esophagitis show resistance to PPI treatment. |