Refractory regurgitation responds to magnetic sphincter augmentation but not to increased proton pump inhibitor dose

Purpose of review Precision treatment of medically-refractory regurgitation differs from that of heartburn. Regurgitation is an often-overlooked symptom characterized as a bitter taste in the mouth or a sense of fluid moving up from the stomach occurring in approximately 80% of gastroesophageal reflux disease (GERD) patients with varying severity. Its response to standard medical therapy is significantly less than heartburn while significantly lessening quality of life in 10–20% of GERD patients. Recent findings The therapeutic gain of proton pump inhibitors (PPIs) above placebo averages 17% for regurgitation compared with 41% for heartburn. Increased dosing of medication is commonly, yet futilely, used. The symptom is probably mediated more by fluid volume than by the acidity of the refluxate. PPIs significantly decrease gastric acid secretion and to some extent volume of gastric juice. Significantly, doubling the PPI dose does not incrementally decrease gastric juice volume though it may decrease gastric acid secretion further. Studies on refractory regurgitation using some of the newer antireflux procedures (magnetic sphincter augmentation and transoral fundoplication) demonstrated success in over 85% of patients whereas increased PPI dosing helped in approximately 15%. Summary Precision care of regurgitation should recognize the low-therapeutic impact of acid control, while antireflux procedures are very successful.

show abstract

Refractory regurgitation responds to magnetic sphincter augmentation but not to increased proton pump inhibitor dose

Abstract: If medical therapy is not helpful, the next question is this: How does MSA compare with traditional fundoplication? This is a more difficult, as yet unanswered, question.

Cited by 3 publications

References 14 publications

Use of Magnets in Flexible Endoscopy

Use of Magnets in Flexible Endoscopy

Chinese consensus on multidisciplinary diagnosis and treatment of gastroesophageal reflux disease 2022

Management of regurgitation in patients with gastroesophageal reflux disease

Contact Info

Product

Resources

About