PPI-Refractory GERD: an Intriguing, Probably Overestimated, Phenomenon

<p>Barrier Effect of a New Topical Agent on Damaged Esophageal Mucosa: Experimental Study on an ex vivo Swine Model</p>

“…It is now well established that the mechanisms underlying symptoms in GERD patients are not only related to esophageal acid exposure, but also to enhanced esophageal sensitivity due to increased mucosal permeability, thus explaining the partial failure of anti-secretory therapy in these patients. [1][2][3][4] The esophageal mucosa consists of a stratified squamous epithelium which acts as a tight defensive barrier against the injurious components of the gastroesophageal refluxate, and its impairment has been demonstrated not only in patients with mucosal erosions (esophagitis) but also in those with an apparently normal mucosa (NERD), who represent the most common GERD phenotype. [5][6][7] In recent years, several experimental studies aimed at demonstrating the possibility of strengthening the mucosal barrier by means of topical products containing combinations of hyaluronic acid, chondroitin sulfate, alginates and antacids have been carried out on both animal models and humans.…”

Management Options for Patients With GERD and Persistent Symptoms on Proton Pump Inhibitors: Recommendations From an Expert Panel

“…However, 10 to 40% of patients with GERD remain symptomatic despite PPI therapy. 1 Heterogeneous mechanisms may contribute to poor PPI response including a disrupted anti-reflux barrier, increased transient lower esophageal sphincter (LES) relaxations (TLESRs), reduced esophageal mucosal barrier function, impaired esophageal clearance and inadequate acid suppression. 2 Furthermore, reflux hypersensitivity and psychosocial factors may drive symptom perception regardless of whether or not excessive reflux burden is present.…”