Refractory gastroesophageal reflux disease

Subramanian, C. R.; Triadafilopoulos, George

doi:10.1093/gastro/gou061

Cited by 63 publications

(60 citation statements)

References 84 publications

(92 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, even today it remains unclear the clinical significance of this phenom- enon and whether it is related to the lack of therapeutic response to these medications. Other causes of refractoriness to the treatment include poor compliance, hypotensive lower esophageal sphincter and ineffective esophageal peristalsis (62). One of the tested treatments to treat dyspepsia (not investigated and functional) is the use of PPIs (63).…”

Section: Indications Of Ppismentioning

confidence: 99%

Practical considerations in the management of proton-pump inhibitors

Aguilera¹,

Martín-de-Argila-dePrados²,

Albillos-Martínez³

2015

Rev Esp Enferm Dig

View full text Add to dashboard Cite

Proton-pump inhibitors (PPIs) are one of the most active ingredients prescribed in Spain. In recent decades there has been an overuse of these drugs in both outpatient clinics and hospitals that has lead to a significant increase in healthcare spending and to an increase in the risk of possible side effects. It is important for health professionals to know the accepted indications and the correct doses for the use of these drugs. On the market there are different types of PPI: omeprazole, pantoprazole, lansoprazole, rabeprazole and esomeprazole. Omeprazole is the oldest and most used PPI, being also the cheapest. Although there are no important differences between PPIs in curing diseases, esomeprazole, a newgeneration PPI, has proved to be more effective in eradicating H. pylori and in healing severe esophagitis compared to other PPIs. In recent years the use of generic drugs has spread; these drugs have the same bioavailability than the original drugs. In the case of PPIs, the few comparative studies available in the literature between original and generic drugs have shown no significant differences in clinical efficacy.Key words: Proton-pump inhibitor. PPI. Omeprazole. Pantoprazole. Lansoprazole. Rabeprazole. Esomeprazole. INTRODUCTIONProton-pump inhibitors (PPIs) represent a family of drugs widely used in our country. The advent in the nineties of PPIs was a great revolution in the treatment of ulcer disease and gastroesophageal reflux. The main problems of PPIs at present time are its overuse and the errors in the therapeutic indication. This fact leads to a considerable health economic cost and the risk of long-term side effects. In this review the main problems of PPIs prescription, their indications, the differences between PPIs and tips on their use are discussed. Brief historical memory: since alkaline diets until PPIsThe treatment of ulcer disease and gastroesophageal reflux disease (GERD) in the early twentieth century was the prescription of alkaline foods like milk, eggs and puree (1). Later, there were products as sodium bicarbonate that improved symptoms but did not prevent complications. Surgical treatment consisted of different types of gastric surgeries for peptic ulcer disease and Nissen fundoplication for GERD (2).In the mid twentieth century the use of muscarinic antagonists was introduced, atropine being its main active ingredient. Acids secretion was partially inhibited by blocking the muscarinic receptor of the parietal cell. However, these drugs had little effectiveness and numerous adverse effects due to the amount of muscarinic receptors distributed throughout the body. E-type prostaglandin was discovered later, but, again, the limitations of these substances were their short half life and side effects. An important progress in gastric antisecretory therapy was the appearance of H 2 receptors antagonists (H 2 blockers) (3). The most used were ranitidine and famotidine. These drugs established a substantial change by blocking the action of histamine receptor in gastric parietal ...

show abstract

Section: Indications Of Ppismentioning

confidence: 99%

Practical considerations in the management of proton-pump inhibitors

Aguilera¹,

Martín-de-Argila-dePrados²,

Albillos-Martínez³

2015

Rev Esp Enferm Dig

View full text Add to dashboard Cite

show abstract

“…Fundoplication associated with esophageal hiatus calibration is the only one that can restore the anti-reflux barrier in patients with GERD, with the disappearance of typical and atypical symptoms in most patients and improvement of quality of life: restores LES function, prevents acid and non-acid reflux, reduces BE and EAC risk, restores the anatomy of the gastroesophageal junction in those with HH. Good results at a distance are present in over 90% of cases (12). Of course, there are some inconveniences (14,15):…”

Section: Introductionmentioning

confidence: 99%

“…Recently, those refractory to PPIs respond to vanoprazan, a "potassium-competitive acid blocker" that has a much stronger inhibitory effect on acid secretion from gastric parietal cells. Baclofen is also efficient in reducing transient relaxation of the LES, a "GABA-B agonist", which unfortunately also has side effects, reason for which it is not approved by the FDA (11,12).…”

Section: Introductionmentioning

confidence: 99%

“…Surgical treatment is recommended especially for patients with no response to MT, those with atypical symptoms, with large HH, with EE, with complications (stenosis, BE), those with defective LES (4,14,15). Considering that 30-40% of patients respond partially to MT or do not respond at all, but are also reluctant to surgery out of fear of postoperative side effects, there is a "therapeutic gap" -patients with GERD who do not benefit from an effective treatment (9,21). For over 15 years, minimally invasive therapies have been developed specifically for these patients.…”

Section: Introductionmentioning

confidence: 99%

“…At the same time, in the case of recurrence of GERD, LF can be performed. These techniques selectively address patients who do not present important anatomical changes (HH> 2-3cm), do not have severe reflux (esophagitis Los Angeles grade C, D, esophageal stenosis, BE) (21,22,23).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

New Minimally Invasive Endoscopic and Surgical Therapies for Gastroesophageal Reflux Disease (GERD)

Nicolau¹,

Lobonţiu²,

Constantinoiu³

2018

chr

View full text Add to dashboard Cite

RezumatBRGE a devenit cea mai frecventã afecţiune a polului digestiv superior, afecţiune spectralã şi evolutivã cu posibile complicaţii severe. Terapia principalã şi efectivã în majoritatea cazurilor este tratamentul medical (TM) axat pe IPP. Cazurile severe cu alterarea funcţiei sfincterului esofagian inferior (SEI) şi modificãri anatomice importante vor fi abordate chirurgical, fundoplicatura laparoscopicã (FL), intervenţia de elecţie, cu rezultate bune la distanţã, dar cu posibile efecte negative postoperatorii. 30-40 % dintre pacienţi sunt refractãri la TM, dar mulţi nu doresc intervenţia chirurgicalã. Apare un "gol terapeutic", pacienţi cu BRGE care nu beneficiazã de tratament. Pentru pacienţii cu BRGE, selectaţi, fãrã forme severe şi complicaţii şi fãrã modificãri anatomice importante (hernii hiatale mici), în mod special pentru cei refractari la TM, au apãrut noi terapii miniminvazive: mai eficiente ca şi TM, dar mai puţin agresive şi cu efecte secundare minime comparativ cu FL. Sunt terapii endoscopice care amelioreazã funcţia SEI prin terapie termicã, procedeul Stretta® şi rezecţia mucoasei antireflux, respectiv realizarea unei fundoplicaturi parţiale cu ajutorul unor dipozitive de agrafare: EsophyX®, Muse™, Gerd-X™. Tehnicile laparoscopice pot rezolva HH mai mari (peste 2 cm) când se impune, iar în locul fundoplicaturii se poate monta un şirag de mãrgele magnetice la nivelul joncţiunii gastroesofagiene, procedeul LINX®, respectiv electrozi pentru stimulare electricã a SEI, EndoStim®. Aceste procedee s-au dovedit

show abstract

Diseases of the Gastrointestinal Tract

Sanderson¹,

Escudier²

2021

Burket's Oral Medicine

View full text Add to dashboard Cite

Refractory gastroesophageal reflux disease

Cited by 63 publications

References 84 publications

Practical considerations in the management of proton-pump inhibitors

Practical considerations in the management of proton-pump inhibitors

New Minimally Invasive Endoscopic and Surgical Therapies for Gastroesophageal Reflux Disease (GERD)

Diseases of the Gastrointestinal Tract

Contact Info

Product

Resources

About