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      Proton pump inhibitor-refractory gastroesophageal reflux disease: challenges and solutions

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          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.

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          Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease.

          , Donald Castell, Kenneth DeVault (2004)
          Guidelines for the diagnosis and treatment of gastroesophageal reflux disease (GERD) were published in 1995 and updated in 1999. These and other guidelines undergo periodic review. Advances continue to be made in the area of GERD, leading us to review and revise previous guideline statements. GERD is defined as symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus. These guidelines were developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee, and approved by the Board of Trustees. Diagnostic guidelines address empiric therapy and the use of endoscopy, ambulatory reflux monitoring, and esophageal manometry in GERD. Treatment guidelines address the role of lifestyle changes, patient directed (OTC) therapy, acid suppression, promotility therapy, maintenance therapy, antireflux surgery, and endoscopic therapy in GERD. Finally, there is a discussion of the rare patient with refractory GERD and a list of areas in need of additional study.
          Article 0 comments Cited 124 times – based on 0 reviews     Review now
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            Rikkunshito, an herbal medicine, suppresses cisplatin-induced anorexia in rats via 5-HT2 receptor antagonism.

            Hiroshi Takeda, Chiharu Sadakane, Tomohisa Hattori … (2008)
            Chemotherapy with an anticancer agent generally causes gastrointestinal tract disorders such as vomiting and anorexia, but the mechanism remains unclear. Rikkunshito, a kampo preparation, is known to alleviate such adverse reactions. In this study, we attempted to clarify the mechanism. We investigated the decreases of plasma acylated-ghrelin level and food intake caused by cisplatin, serotonin (5-HT), 5-HT agonists, and vagotomy as well as the decrease-suppressing effects of rikkunshito and 5-HT antagonists. In addition, binding affinities of rikkunshito components were determined in receptor-binding assays using 5-HT2B and 5-HT2C receptors. Cisplatin, 5-HT, BW723C86 (5-HT2B-receptor agonist), and m-chlorophenylpiperazine HCl (5-HT2C agonist) markedly decreased plasma acylated-ghrelin levels, although 5-HT3 and 5-HT4 agonists had no effect. In contrast, 5-HT2B and 5-HT2C antagonists suppressed the cisplatin-induced decrease of plasma acylated-ghrelin level and food intake. Administration of rat ghrelin improved the cisplatin-induced decrease in food intake. Vagotomy decreased the plasma acylated-ghrelin level, which was decreased further by cisplatin. Rikkunshito suppressed such cisplatin-induced decreases of plasma acylated-ghrelin level and food intake. The suppressive effect of rikkunshito was blocked by a ghrelin antagonist. Components of rikkunshito, 3,3',4',5,6,7,8-heptamethoxyflavone, hesperidin, and iso-liquiritigenin showed a 5-HT2B-antagonistic effect in vitro, and oral administration of rikkunshito suppressed the cisplatin-induced decrease in the plasma acylated-ghrelin level. The cisplatin-induced decreases of the plasma acylated-ghrelin level and food intake are mediated by 5-HT2B/2C receptors and suppressed by flavonoids in rikkunshito.
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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)
              Article 0 comments Cited 94 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Exp Gastroenterol
                Journal ID (iso-abbrev): Clin Exp Gastroenterol
                Journal ID (publisher-id): Clinical and Experimental Gastroenterology
                Title: Clinical and Experimental Gastroenterology
                Publisher: Dove Medical Press
                ISSN (Electronic): 1178-7023
                Publication date Collection: 2018
                Publication date (Electronic): 21 March 2018
                Volume: 11
                Pages: 119-134
                Affiliations
                [1 ]Gasteroenterology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
                [2 ]Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
                [3 ]Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
                Author notes
                Correspondence: Maxwell M Chait, Columbia Doctors Medical Group, 180 East Hartsdale Avenue, Hartsdale, NY 10530, USA, Tel +1 914 725 2010, Fax +1 914 725 6488, Email maxwellchait@ 123456gmail.com
                Article
                Publisher ID: ceg-11-119
                DOI: 10.2147/CEG.S121056
                PMC ID: 5868737
                PubMed ID: 29606884
                SO-VID: 18536754-86a5-49a9-bedf-155618ab4e93
                Copyright © © 2018 Mermelstein et al. This work is published and licensed by Dove Medical Press Limited
                License:

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Subject: Review

                ScienceOpen disciplines: Gastroenterology & Hepatology
                Keywords: ppi failure,resistant gerd,acid-related diseases,gastroesophageal reflux disease,acid reflux,proton pump inhibitors
                Data availability:
                ScienceOpen disciplines: Gastroenterology & Hepatology
                Keywords: ppi failure, resistant gerd, acid-related diseases, gastroesophageal reflux disease, acid reflux, proton pump inhibitors

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