| Theme |
GERD in Clinical Practice 2018 -- Current Status and Issues |
| Title |
Treatment of GERD -- Management of Patients Refractory to PPI |
| Author |
Kyoichi Adachi |
Health Center, Shimane Environment and Health Public Corporation |
| Author |
Mayumi Okada |
Health Center, Shimane Environment and Health Public Corporation |
| Author |
Eiko Okimoto |
Health Center, Shimane Environment and Health Public Corporation |
| Author |
Tomoko Mishiro |
Health Center, Shimane Environment and Health Public Corporation |
| [ Summary ] |
Proton pump inhibitors (PPIs) are the primary medications used to treat patients with gastroesophageal reflux disease (GERD). However, PPI therapy may not successfully heal the mucosal breaks observed in a few patients with erosive GERD. Additionally, PPI therapy may not successfully provide symptom relief in some patients presenting with GERD. A double dose of PPI administered twice a day is effective to control gastric acid secretion over 24 hours in PPI‒refractory cases showing severe erosive GERD. On the other hand, several factors could contribute to the occurrence of resistance to PPI therapy in the patients with non‒erosive GERD (NERD). Esophageal impedance and pH monitoring testing and/or esophageal manometry are recommended to determine the factors causing PPI‒refractory NERD in these patients, and surgical therapy and psychological approaches might be needed in the patients with PPI‒refractory NERD. |