A debate on the roles of antireflux surgery and long term acid suppression in the management of gastro-oesophageal reflux disease: Table 1

Galmiche, Jean Paul

doi:10.1136/fg.2010.003962

Cited by 4 publications

(2 citation statements)

References 43 publications

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“…Despite the high expectations and the promising initial results, the disappointing clinical benefit in larger clinical trials has led pharmaceutical companies to halt further drug development and end their GERD reflux inhibitor program 51 . Although effective in carefully selected patients, antireflux surgery should be considered as the last resort, as it brings about some postoperative morbidity and, albeit very rarely, mortality 52 . A better and more predictable form of acid suppression should therefore be pursued.…”

Section: Ppi‐refractory Gerd: Is An Extended Acid Suppression the Ansmentioning

confidence: 99%

Poor effectiveness of proton pump inhibitors in non‐erosive reflux disease: the truth in the end!

Scarpignato

2012

Neurogastroenterology Motil

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Despite acid secretion being normal in the majority of patients with gastro‐esophageal reflux disease (GERD) or Barrett’s esophagus, acid inhibition represents the mainstay of treatment for both these conditions, with the aim of reducing the aggressive nature of the refluxate toward the esophageal mucosa. Proton pump inhibitors (PPIs) represent, therefore, the first choice medical treatment for GERD, in that they are able to provide an 80–85% healing rate for esophageal lesions, a 56–76% symptom relief and also reduce the incidence of complications, such as strictures as well as dysplasia and adenocarcinoma in Barrett’s esophagus. According to a widely quoted systematic review, compared to patients with erosive esophagitis, patients with non‐erosive reflux disease (i.e., NERD) display a reduced symptom relief with PPIs, with about 20% reduction of therapeutic gain. In this issue of NeuroGastroenterology & Motility, Weijenborg et al. address for the first time the PPI efficacy in subpopulations of patients with NERD. The study shows clearly that, when the diagnosis is accurately made by including a functional test, NERD patients respond to PPI therapy in a similar way to those with erosive disease. Although not as frequent as previously suggested, however, PPI‐refractory heartburn does exist. Some 20% (range: 15–27%) of correctly diagnosed and appropriately treated patients do not respond to PPI treatment at standard doses. Although the pathophysiology underlying PPI failure in GERD is complex and likely multifactorial, acid (be it the sole component of refluxate or not) still remains a major causative factor. A better and more predictable form of acid suppression should therefore be pursued.

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Section: Ppi‐refractory Gerd: Is An Extended Acid Suppression the Ansmentioning

confidence: 99%

Poor effectiveness of proton pump inhibitors in non‐erosive reflux disease: the truth in the end!

Scarpignato

2012

Neurogastroenterology Motil

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“…To address the chronic and relapsing nature of GERD, two treatment options are available and these are long-term medication and surgery. The advantages and disadvantages of long-term medical treatment and surgery are shown in Table 2 [ 104 ]. A multicentre study which compared optimized esomeprazole therapy and standard laparoscopic antireflux surgery (LARS) in patients with GERD demonstrated that both approaches are equally effective as most patients achieve and remain in remission at 5 years [ 105 ].…”

Section: Surgerymentioning

confidence: 99%

Current Trends in the Management of Gastroesophageal Reflux Disease: A Review

Nwokediuko

2012

ISRN Gastroenterology

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Gastroesophageal reflux disease (GERD) is a chronic disorder of the upper gastrointestinal tract with global distribution. The incidence is on the increase in different parts of the world. In the last 30 to 40 years, research findings have given rise to a more robust understanding of its pathophysiology, clinical presentation, and management. The current definition of GERD (The Montreal definition, 2006) is not only symptom-based and patient-driven, but also encompasses esophageal and extraesophageal manifestations of the disease. The implication is that the disease can be confidently diagnosed based on symptoms alone. Nonerosive reflux disease (NERD) remains the predominant form of GERD. Current thinking is that NERD and erosive reflux disease (ERD) are distinct phenotypes of GERD rather than the old concept which regarded them as components of a disease spectrum. Non erosive reflux disease is a very heterogeneous group with significant overlap with other functional gastrointestinal disorders. There is no gold standard for the diagnosis of GERD. Esophageal pH monitoring and intraluminal impedance monitoring have thrown some light on the heterogeneity of NERD. A substantial proportion of GERD patients continue to have symptoms despite optimal PPI therapy, and this has necessitated research into the development of new drugs. Several safety concerns have been raised about chronic use of proton pump inhibitors but these are yet to be substantiated in controlled studies. The debate about efficacy of long-term medical treatment compared to surgery continues, however, recent data indicate that modern surgical techniques and long-term PPI therapy have comparable efficacy. These and other issues are subjects of further research.

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Overview: The Post-repair Issues and the Active Pursuit of Normalcy

Foker

2017

Esophageal and Gastric Disorders in Infancy and Childhood

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A debate on the roles of antireflux surgery and long term acid suppression in the management of gastro-oesophageal reflux disease: Table 1

Cited by 4 publications

References 43 publications

Poor effectiveness of proton pump inhibitors in non‐erosive reflux disease: the truth in the end!

Poor effectiveness of proton pump inhibitors in non‐erosive reflux disease: the truth in the end!

Current Trends in the Management of Gastroesophageal Reflux Disease: A Review

Overview: The Post-repair Issues and the Active Pursuit of Normalcy

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