Title |
Proton pump inhibitor-refractory gastroesophageal reflux disease: challenges and solutions
|
---|---|
Published in |
Clinical and Experimental Gastroenterology, March 2018
|
DOI | 10.2147/ceg.s121056 |
Pubmed ID | |
Authors |
Joseph Mermelstein, Alanna Chait Mermelstein, Maxwell M Chait |
Abstract |
A significant percentage of patients with gastroesophageal reflux disease (GERD) will not respond to proton pump inhibitor (PPI) therapy. The causes of PPI-refractory GERD are numerous and diverse, and include adherence, persistent acid, functional disorders, nonacid reflux, and PPI bioavailability. The evaluation should start with a symptom assessment and may progress to imaging, endoscopy, and monitoring of esophageal pH, impedance, and bilirubin. There are a variety of pharmacologic and procedural interventions that should be selected based on the underlying mechanism of PPI failure. Pharmacologic treatments can include antacids, prokinetics, alginates, bile acid binders, reflux inhibitors, and antidepressants. Procedural options include laparoscopic fundoplication and LINX as well as endoscopic procedures, such as transoral incisionless fundoplication and Stretta. Several alternative and complementary treatments of possible benefit also exist. |
X Demographics
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Geographical breakdown
Country | Count | As % |
---|---|---|
United States | 1 | 100% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Practitioners (doctors, other healthcare professionals) | 1 | 100% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 91 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Master | 13 | 14% |
Researcher | 11 | 12% |
Student > Bachelor | 9 | 10% |
Other | 6 | 7% |
Lecturer | 5 | 5% |
Other | 16 | 18% |
Unknown | 31 | 34% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 29 | 32% |
Nursing and Health Professions | 8 | 9% |
Pharmacology, Toxicology and Pharmaceutical Science | 6 | 7% |
Biochemistry, Genetics and Molecular Biology | 5 | 5% |
Unspecified | 2 | 2% |
Other | 6 | 7% |
Unknown | 35 | 38% |