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      Refractory gastroesophageal reflux disease

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          Abstract

          Gastroesophageal reflux disease (GERD) is a condition that develops when the reflux of stomach contents into the esophagus causes troublesome symptoms, esophageal injury, and/or complications. Use of proton pump inhibitors (PPI) remains the standard therapy for GERD and is effective in most patients. Those whose symptoms are refractory to PPIs should be evaluated further and other treatment options should be considered, according to individual patient characteristics. Response to PPIs could be total (no symptoms), partial (residual breakthrough symptoms), or absent (no change in symptoms). Patients experiencing complete response do not usually need further management. Patients with partial response can be treated surgically or by using emerging endoscopic therapies. Patients who exhibit no response to PPI need further evaluation to rule out other causes.

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          Epidemiology of gastro-oesophageal reflux disease: a systematic review.

          J. Dent, H B El-Serag, M.-A. Wallander … (2005)
          A systematic review of the epidemiology of gastro-oesophageal reflux disease (GORD) has been performed, applying strict criteria for quality of studies and the disease definition used. The prevalence and incidence of GORD was estimated from 15 studies which defined GORD as at least weekly heartburn and/or acid regurgitation and met criteria concerning sample size, response rate, and recall period. Data on factors associated with GORD were also evaluated. An approximate prevalence of 10-20% was identified for GORD, defined by at least weekly heartburn and/or acid regurgitation in the Western world while in Asia this was lower, at less than 5%. The incidence in the Western world was approximately 5 per 1000 person years. A number of potential risk factors (for example, an immediate family history and obesity) and comorbidities (for example, respiratory diseases and chest pain) associated with GORD were identified. Data reported in this systematic review can be interpreted with confidence as reflecting the epidemiology of "true" GORD. The disease is more common in the Western world than in Asia, and the low rate of incidence relative to prevalence reflects its chronicity. The small number of studies eligible for inclusion in this review highlights the need for global consensus on a symptom based definition of GORD.
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            American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease.

            Peter Kahrilas, Nicholas J. Shaheen, Michael F. Vaezi (2008)
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              Laparoscopic antireflux surgery vs esomeprazole treatment for chronic GERD: the LOTUS randomized clinical trial.

              Christian Ell, Tore Lind, Stephen Attwood … (2011)
              Gastroesophageal reflux disease (GERD) is a chronic, relapsing disease with symptoms that have negative effects on daily life. Two treatment options are long-term medication or surgery. To evaluate optimized esomeprazole therapy vs standardized laparoscopic antireflux surgery (LARS) in patients with GERD. The LOTUS trial, a 5-year exploratory randomized, open, parallel-group trial conducted in academic hospitals in 11 European countries between October 2001 and April 2009 among 554 patients with well-established chronic GERD who initially responded to acid suppression. A total of 372 patients (esomeprazole, n = 192; LARS, n = 180) completed 5-year follow-up. Interventions Two hundred sixty-six patients were randomly assigned to receive esomeprazole, 20 to 40 mg/d, allowing for dose adjustments; 288 were randomly assigned to undergo LARS, of whom 248 actually underwent the operation. Time to treatment failure (for LARS, defined as need for acid suppressive therapy; for esomeprazole, inadequate symptom control after dose adjustment), expressed as estimated remission rates and analyzed using the Kaplan-Meier method. Estimated remission rates at 5 years were 92% (95% confidence interval [CI], 89%-96%) in the esomeprazole group and 85% (95% CI, 81%-90%) in the LARS group (log-rank P = .048). The difference between groups was no longer statistically significant following best-case scenario modeling of the effects of study dropout. The prevalence and severity of symptoms at 5 years in the esomeprazole and LARS groups, respectively, were 16% and 8% for heartburn (P = .14), 13% and 2% for acid regurgitation (P < .001), 5% and 11% for dysphagia (P < .001), 28% and 40% for bloating (P < .001), and 40% and 57% for flatulence (P < .001). Mortality during the study was low (4 deaths in the esomeprazole group and 1 death in the LARS group) and not attributed to treatment, and the percentages of patients reporting serious adverse events were similar in the esomeprazole group (24.1%) and in the LARS group (28.6%). This multicenter clinical trial demonstrated that with contemporary antireflux therapy for GERD, either by drug-induced acid suppression with esomeprazole or by LARS, most patients achieve and remain in remission at 5 years. clinicaltrials.gov Identifier: NCT00251927.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Gastroenterol Rep (Oxf)
                Journal ID (iso-abbrev): Gastroenterol Rep (Oxf)
                Journal ID (publisher-id): gastro
                Journal ID (hwp): gastro
                Title: Gastroenterology Report
                Publisher: Oxford University Press
                ISSN (Electronic): 2052-0034
                Publication date (Print): February 2015
                Publication date (Electronic): 30 September 2014
                Volume: 3
                Issue: 1
                Pages: 41-53
                Affiliations
                1Internal Medicine, Guthrie Clinic, Sayre, PA, USA and 2Division of Gastroenterology, Stanford University School of Medicine, Stanford, CA, USA
                Author notes
                * Corresponding author. Division of Gastroenterology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94035, USA. Tel: +1-650-988-7488; Fax: +1-650-988-7486; Email: vagt@ 123456stanford.edu
                Article
                Publisher ID: gou061
                DOI: 10.1093/gastro/gou061
                PMC ID: 4324866
                PubMed ID: 25274499
                SO-VID: 092b8e7d-de10-4261-9116-3a3176beaf95
                Copyright © © The Author(s) 2014. Published by Oxford University Press and the Digestive Science Publishing Co. Limited.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 20 July 2014
                Date revision received : 26 July 2014
                Date accepted : 31 July 2014
                Page count
                Pages: 13
                Categories
                Subject: Reviews

                Keywords: gastroesophageal reflux disease,acid-related diseases,ph monitoring,endoscopy
                Data availability:
                Keywords: gastroesophageal reflux disease, acid-related diseases, ph monitoring, endoscopy

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