Effectiveness of proton pump inhibitors in nonerosive reflux disease

Dean, Bonnie B.; Gano, Anacleto D.; Knight, Kevin; Ofman, Joshua J.; Fass, Ronnie

doi:10.1016/s1542-3565(04)00288-5

Cited by 423 publications

(343 citation statements)

References 23 publications

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“…In contrast, consistently and significantly worse outcomes are reported for medical treatment for NERD compared to erosive disease. [16][17][18] Lind et al, for example, documented complete symptom resolution in only 46% of NERD patients using 20 mg omeprazole daily for 4 weeks, and satisfaction with therapy was reported by only two thirds of patients. 35 In a pooled data study of 2,458 patients who received differing but standard PPI doses, complete heartburn resolution was achieved in only 63% of patients at the end of 4 weeks' treatment.…”

Section: Discussionmentioning

confidence: 99%

“…13,15 The results of surgical treatment are especially important for patients with NERD as medical treatments are widely reported as being less effective for these patients. [16][17][18] In this study, we investigated the influence of the endoscopically defined GERD stage on the outcome of laparoscopic Nissen fundoplication. We also compared the demographic, clinical, and physiologic features of patients with different stages of GERD.…”

Section: Introductionmentioning

confidence: 99%

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Hiatal Hernia, Lower Esophageal Sphincter Incompetence, and Effectiveness of Nissen Fundoplication in the Spectrum of Gastroesophageal Reflux Disease

Lord

DeMeester

Peters

et al. 2009

Journal of Gastrointestinal Surgery

119

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Background and Aims Gastroesophageal reflux disease (GERD) is a spectrum of disease that includes nonerosive reflux disease (NERD), erosive reflux disease (ERD), and Barrett's esophagus (BE). Treatment outcomes for patients with different stages have differed in many studies. In particular, acid suppressant medication therapy is reported to be less effective for treating patients with NERD and Barrett's esophagus. The aims of this study were to investigate (1) the role of mechanical factors including hiatal hernia and lower esophageal sphincter (LES) competence in the spectrum of GERD and (2) outcomes of Nissen fundoplication. Methods From the records of patients who had undergone laparoscopic Nissen fundoplication after an abnormal pH study, we identified 50 symptomatic consecutive patients with each of the GERD stages: (1) NERD, (2) mild ERD, defined as esophagitis that was healed with acid suppression therapy, (3) severe ERD, defined as esophagitis that persisted despite medical therapy, and (4) BE. Exclusion criteria were normal distal esophageal acid exposure, esophageal pH monitoring performed elsewhere, antireflux surgery less than 1 year previously or previous fundoplication, and a named esophageal motility disorder or distal esophageal low amplitude hypomotility. Patients who could not be contacted for the study were also excluded. All patients completed a detailed preoperative questionnaire; underwent preoperative upper gastrointestinal endoscopy, stationary manometry, and distal esophageal pH monitoring; and were interviewed at least 1 year after operation. Results One hundred sixty patients meeting the entry criteria were studied. The mean follow-up period was 36.7 months. The only significant preoperative symptom difference was that patients with BE had more moderately severe or severe dysphagia compared to patients with NERD. Patients with severe ERD or BE had a significantly higher prevalence of hiatal hernia, lower LES pressures, and more esophageal acid exposure. Hiatal hernia and hypotensive LES were present in most patients with severe ERD or BE but in only a minority of patients with NERD or mild ERD. Surgical therapy resulted in similarly excellent symptom outcomes for patients in all GERD categories. Conclusions Compared to mild ERD and NERD, severe ERD and BE are associated with significantly greater loss of the mechanical antireflux barrier as reflected in the presence of hiatal hernia and LES measurements. Restoration of the antireflux barrier and hernia reduction by laparoscopic Nissen fundoplication provides similarly excellent symptom control in all patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hiatal Hernia, Lower Esophageal Sphincter Incompetence, and Effectiveness of Nissen Fundoplication in the Spectrum of Gastroesophageal Reflux Disease

Lord

DeMeester

Peters

et al. 2009

Journal of Gastrointestinal Surgery

119

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“…the endoscopic features of refl ux esophagitis are absent) have a 20% reduction in therapeutic gain from PPIs. (13) Apart from the high treatment costs, it has been observed that up to 55% of patients with persistent GERD symptoms report an impaired quality of life. (14) …”

Section: How Common Is This In My Practice?mentioning

confidence: 99%

Persistent gastro-oesophageal reflux symptoms despite proton pump inhibitor therapy

Ang

How

2016

smedj

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“…Примерно для 20-30% больных, особенно с неэрозивной ГЭРБ и (или) внепище-водными ее проявлениями, исходно характерен плохой ответ на терапию ИПП [20][21][22]. Среди причин, определяющих недоста-точную эффективность ИПП, называют низкую приверженность лечению, снижение биодоступности и быстрый метаболизм ИПП, истинную резистентность к ИПП, ночной кислотный про-рыв, постпрандиальный кислотный карман.…”

Section: терапевтический архив 5 2015unclassified

Alginates in therapy for gastroesophageal reflux disease

Vg¹

2015

Ter. arkh.

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Гастроэзофагеальная рефлюксная болезнь (ГЭРБ) -это со-стояние, при котором рефлюкс содержимого желудка вызывает появление беспокоящих пациента симптомов и (или) развитие осложнений [1]. Распространенность заболевания чрезвычайно высока: в странах Западной Европы, Северной и Южной Амери-ки она составляет 10-20%, в России -13,3%, в Москве достигает 23,6% [2,3] В соответствии с Монреальским консенсусом среди много-образных проявлений ГЭРБ выделяют синдромы эзофагеаль-ные и экстраэзофагеальные. К первым относят, при отсутствии повреждения пищевода, типичный рефлюксный синдром и синдром рефлюксной боли в грудной клетке, при повреждении пищевода -рефлюкс-эзофагит, рефлюксные стриктуры пище-вода, пищевод Баррета и аденокарциному пищевода. Экстраэ-зофагеальные синдромы могут иметь связь с ГЭРБ установлен-ную (синдром рефлюксного кашля, рефлюксный астматиче-ский синдром, рефлюксный ларингит, эрозии зубной эмали) или предполагаемую (фарингит, синусит, рецидивирующий средний отит, идиопатический фиброз легких). Диагноз ГЭРБ может быть поставлен только при наличии характерных сим-птомов (изжога и регургитация) или на основании результатов исследований, демонстрирующих наличие рефлюкса содержи-мого желудка (рН-метрия, импедансометрия) или его повреж-дающее влияние (эндоскопия, гистологическое исследование, электронная микроскопия) [1].Основными целями терапии ГЭРБ являются купирование симптомов, улучшение самочувствия (качества жизни пациен-тов), лечение и предотвращение осложнений, прежде всего реф-люкс-эзофагита.В основе ГЭРБ лежит в первую очередь нарушение двига-тельной функции нижнего пищеводного сфинктера (НПС) и Аннотация В статье представлены данные о распространенности гастроэзофагеальной рефлюксной болезни (ГЭРБ), освещены основные варианты ее лечения. Среди лекарственных средств особое место отведено альгинатам, описаны основные механизмы их действия. Приводятся сведения об эффективности в лечении ГЭРБ альгинатов, включая альгинат-антацидный препарат «Гевискон Двойное Действие», представлены рекомендации по использованию этих препаратов. Ключевые слова: гастроэзофагеальная рефлюксная болезнь, изжога, постпрандиальный кислотный карман, альгинаты, Гевискон Двойное Действие.This article presents evidence of the prevalence of gastroesophageal reflux disease (GERD) and highlights its main treatment options. Among its medications, particular emphasis is laid on alginates and their main mechanisms of action are described. There is information on the efficacy of alginates, including the alginate-antacid Gaviscon Double Action, in treating GERD. Recommendations for how to administer these drugs are given. Key words: gastroesophageal reflux disease, heartburn, postprandial acid pocket, alginates, Gaviscon Double Action.ГЭРБ -гастроэзофагеальная рефлюксная болезнь НПС -нижний пищеводный сфинктер ИПП -ингибиторы протонной помпы ГПОД -грыжа пищеводного отверстия диафрагмы грудного отдела пищевода, из-за которого становится возмож-ным заброс агрессивных субстанций из желудка и двенадцати-перстной кишки в пищевод [4]. В настояще...

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Effectiveness of proton pump inhibitors in nonerosive reflux disease

Cited by 423 publications

References 23 publications

Hiatal Hernia, Lower Esophageal Sphincter Incompetence, and Effectiveness of Nissen Fundoplication in the Spectrum of Gastroesophageal Reflux Disease

Hiatal Hernia, Lower Esophageal Sphincter Incompetence, and Effectiveness of Nissen Fundoplication in the Spectrum of Gastroesophageal Reflux Disease

Persistent gastro-oesophageal reflux symptoms despite proton pump inhibitor therapy

Alginates in therapy for gastroesophageal reflux disease

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