期刊
BEST PRACTICE & RESEARCH CLINICAL GASTROENTEROLOGY
卷 27, 期 3, 页码 401-414出版社
ELSEVIER SCI LTD
DOI: 10.1016/j.bpg.2013.06.005
关键词
Oesophagus; Gastroesophageal reflux disease; Ambulatory oesophageal pH monitoring; Ambulatory oesophageal pH-impedance monitoring; Proton pump inhibitors; Visceral hypersensitivity
资金
- United States Public Health Service [R01 DC00646]
Proton pump inhibitors (PPIs) remove most of the acid from the gastroesophageal refluxate. However, PPIs do not eliminate reflux and the response of specific GERD symptoms to PPI therapy depends on the degree to which acid drives those symptoms. PPIs are progressively less effective for heartburn, regurgitation, chest pain and extra-oesophageal symptoms. Hence, with an incomplete PPI response, obtaining an accurate history, detailing which symptoms are 'refractory' and exactly what evidence exists linking these symptoms to GERD is paramount. Reflux can continue to cause symptoms despite PPI therapy because of persistent acid reflux or weakly acidic reflux. Given these possibilities, diagnostic testing (pH or pH-impedance monitoring) becomes essential. Antireflux surgery is an alternative in patients if a clear relationship is established between persistent symptoms, particularly regurgitation, and reflux. Treating visceral hypersensitivity may also benefit the subset of GERD patients whose symptoms are driven by this mechanism. (c) 2013 Elsevier Ltd. All rights reserved.
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