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The Proton Pump Inhibitor Non-Responder: A Clinical Conundrum.

Hussain ZH, Henderson EE, Maradey-Romerao C, George N, Fass R, Lacy BE - Clin Transl Gastroenterol (2015)

Bottom Line: Gastroesophageal reflux disease (GERD) is a highly prevalent chronic condition where in stomach contents reflux into the esophagus causing symptoms, esophageal injury, and subsequent complications.Proton pump inhibitors (PPI) remain the mainstay of therapy for acid suppression.Patients should be assessed for mechanisms that can lead to PPI failure and may require further evaluation to investigate for alternative causes.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology and Hepatology, Area 4C, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.

ABSTRACT
Gastroesophageal reflux disease (GERD) is a highly prevalent chronic condition where in stomach contents reflux into the esophagus causing symptoms, esophageal injury, and subsequent complications. Proton pump inhibitors (PPI) remain the mainstay of therapy for acid suppression. Despite their efficacy, significant proportions of GERD patients are either partial or non-responders to PPI therapy. Patients should be assessed for mechanisms that can lead to PPI failure and may require further evaluation to investigate for alternative causes. This monograph will outline a diagnostic approach to the PPI non-responder, review mechanisms associated with PPI failure, and discuss therapeutic options for those who fail to respond to PPI therapy.

No MeSH data available.


Related in: MedlinePlus

The US GERD population: responders and non-responders. GERD, gastroesophageal reflux disease; PPI, proton pump inhibitor.
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fig1: The US GERD population: responders and non-responders. GERD, gastroesophageal reflux disease; PPI, proton pump inhibitor.

Mentions: PPI non-responders, who demonstrate weakly acidic reflux as the underlying cause of their symptom, should be considered for the following therapeutic modalities, transient lower esophageal sphincter relaxation reducers, pro-motility compounds, endoscopic treatment for GERD, and anti-reflux surgery15 (Figures 1 and 2 and Table 1). As esophageal hypersensitivity has an important role in symptom generation of PPI non-responders with weakly acidic reflux, pain modulators may also provide a therapeutic option22, 61, 62 (Table 2). Non-responders, who demonstrate residual acidic reflux as the underlying cause of their symptoms, should be re-evaluated for lifestyle modifications and proper compliance/adherence as well as considered for other anti-reflux medications such as sucralfate, gaviscon, and H2RAs. In addition, endoscopic treatment for GERD and anti-reflux surgery should be also entertained. The role of pain modulators in this group of patients remains to be elucidated. The last group of PPI non-responders includes patients with functional heartburn. In this group of patients, pain modulators are likely to be the most efficacious therapeutic strategy.


The Proton Pump Inhibitor Non-Responder: A Clinical Conundrum.

Hussain ZH, Henderson EE, Maradey-Romerao C, George N, Fass R, Lacy BE - Clin Transl Gastroenterol (2015)

The US GERD population: responders and non-responders. GERD, gastroesophageal reflux disease; PPI, proton pump inhibitor.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4816276&req=5

fig1: The US GERD population: responders and non-responders. GERD, gastroesophageal reflux disease; PPI, proton pump inhibitor.
Mentions: PPI non-responders, who demonstrate weakly acidic reflux as the underlying cause of their symptom, should be considered for the following therapeutic modalities, transient lower esophageal sphincter relaxation reducers, pro-motility compounds, endoscopic treatment for GERD, and anti-reflux surgery15 (Figures 1 and 2 and Table 1). As esophageal hypersensitivity has an important role in symptom generation of PPI non-responders with weakly acidic reflux, pain modulators may also provide a therapeutic option22, 61, 62 (Table 2). Non-responders, who demonstrate residual acidic reflux as the underlying cause of their symptoms, should be re-evaluated for lifestyle modifications and proper compliance/adherence as well as considered for other anti-reflux medications such as sucralfate, gaviscon, and H2RAs. In addition, endoscopic treatment for GERD and anti-reflux surgery should be also entertained. The role of pain modulators in this group of patients remains to be elucidated. The last group of PPI non-responders includes patients with functional heartburn. In this group of patients, pain modulators are likely to be the most efficacious therapeutic strategy.

Bottom Line: Gastroesophageal reflux disease (GERD) is a highly prevalent chronic condition where in stomach contents reflux into the esophagus causing symptoms, esophageal injury, and subsequent complications.Proton pump inhibitors (PPI) remain the mainstay of therapy for acid suppression.Patients should be assessed for mechanisms that can lead to PPI failure and may require further evaluation to investigate for alternative causes.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology and Hepatology, Area 4C, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.

ABSTRACT
Gastroesophageal reflux disease (GERD) is a highly prevalent chronic condition where in stomach contents reflux into the esophagus causing symptoms, esophageal injury, and subsequent complications. Proton pump inhibitors (PPI) remain the mainstay of therapy for acid suppression. Despite their efficacy, significant proportions of GERD patients are either partial or non-responders to PPI therapy. Patients should be assessed for mechanisms that can lead to PPI failure and may require further evaluation to investigate for alternative causes. This monograph will outline a diagnostic approach to the PPI non-responder, review mechanisms associated with PPI failure, and discuss therapeutic options for those who fail to respond to PPI therapy.

No MeSH data available.


Related in: MedlinePlus