| Theme |
Treatment of Acid‒related Diseases -- the Past, Present and Future |
| Title |
Treatment Strategy for Proton Pump Inhibitor—resistant Reflux Esophagitis |
| Author |
Shintaro Hoshino |
Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine |
| Author |
Noriyuki Kawami |
Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine |
| Author |
Katsuhiko Iwakiri |
Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine |
| [ Summary ] |
Reflux esophagitis (RE) is characterized by excessive esophageal acid exposure. To treat RE, it is necessary to reduce excessive esophageal acid exposure. The first‒line drug for the treatment of RE is a standard‒dose proton‒pump inhibitor (PPI), as recommended by the Evidence‒based Clinical Practice Guidelines 2015 for gastroesophageal disease (GERD) in the Japanese Society of Gastroenterology. It has been reported that the response to a standard dose of PPI in patients with mild RE is 90‒95 %, and in patients with severe RE, it is 80‒85 %. However, PPI‒resistant RE has been increasing. When the standard dose of PPI is not effective, modification of lifestyle with PPI therapy, switching to another PPI, or administration method (before a meal), and double‒dose PPI therapy, may be effective. In addition, potassium‒competitive acid blockers (P‒CAB) were clinically introduced in 2015. The establishment of a new treatment for RE, taking advantage of the promptness and strength of the suppressive action against acid secretion, which are characteristic of P‒CAB, is awaited. |