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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">docru</journal-id><journal-title-group><journal-title xml:lang="ru">Доктор.Ру</journal-title><trans-title-group xml:lang="en"><trans-title>Title</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1727-2378</issn><issn pub-type="epub">2713-2994</issn><publisher><publisher-name>ООО "ГК "РУСМЕДИКАЛ"</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.31550/1727-2378-2022-21-6-35-40</article-id><article-id custom-type="elpub" pub-id-type="custom">docru-46</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ГАСТРОЭНТЕРОЛОГИЯ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>GASTROENTEROLOGY</subject></subj-group></article-categories><title-group><article-title>Современные аспекты диагностики и лечения рефрактерной гастроэзофагеальной рефлюксной болезни</article-title><trans-title-group xml:lang="en"><trans-title>Modern Aspects of Diagnosis and Treatment of Refractory Gastroesophageal Reflux Disease</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-9980-2294</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Цуканов</surname><given-names>В. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Tsukanov</surname><given-names>V. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Цуканов Владислав Владимирович - д. м. н., профессор, заведующий клиническим отделением патологии пищеварительной системы у взрослых и детей</p><p>660022, г. Красноярск, ул. Партизана Железняка, д. 3г.</p></bio><bio xml:lang="en"><p>3-g Partisan Zheleznyak Str., Krasnoyarsk, 660022</p></bio><email xlink:type="simple">gastro@impn.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-6481-3196</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Васютин</surname><given-names>А. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Vasyutin</surname><given-names>A.. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Васютин Александр Викторович - к. м. н., старший научный сотрудник клинического отделения патологии пищеварительной системы у взрослых и детей</p><p>660022, г. Красноярск, ул. Партизана Железняка, д. 3г.</p></bio><bio xml:lang="en"><p>3-g Partisan Zheleznyak Str., Krasnoyarsk, 660022</p></bio><email xlink:type="simple">alexander@kraslan.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Тонких</surname><given-names>Ю. Л.</given-names></name><name name-style="western" xml:lang="en"><surname>Tonkikh</surname><given-names>Yu L.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Тонких Юлия Леонгардовна - к. м. н., ведущий научный сотрудник клинического отделения патологии пищеварительной системы у взрослых и детей</p><p>660022, г. Красноярск, ул. Партизана Железняка, д. 3г.</p></bio><bio xml:lang="en"><p>3-g Partisan Zheleznyak Str., Krasnoyarsk, 660022</p></bio><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ФГБНУ «Федеральный исследовательский центр «Красноярский научный центр» Сибирского отделения Российской академии наук» обособленное подразделение «Научно-исследовательский институт медицинских проблем Севера»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Scientific and Research Institute of Medical Problems of the North of the Federal Research Centre “Krasnoyarsk Scientific Centre of the Siberian Branch of the Russian Academy of Science”</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2022</year></pub-date><pub-date pub-type="epub"><day>14</day><month>02</month><year>2025</year></pub-date><volume>21</volume><issue>6</issue><issue-title>ТЕРАПИЯ</issue-title><fpage>35</fpage><lpage>40</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Цуканов В.В., Васютин А.В., Тонких Ю.Л., 2025</copyright-statement><copyright-year>2025</copyright-year><copyright-holder xml:lang="ru">Цуканов В.В., Васютин А.В., Тонких Ю.Л.</copyright-holder><copyright-holder xml:lang="en">Tsukanov V.V., Vasyutin A.V., Tonkikh Y.L.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://docru.elpub.ru/jour/article/view/46">https://docru.elpub.ru/jour/article/view/46</self-uri><abstract><p>Цель обзора: проанализировать современные данные по диагностике и лечению рефрактерной гастроэзофагеальной рефлюксной болезни (ГЭРБ).Основные положения. Рефрактерную ГЭРБ диагностируют при недостаточном ответе на прием ингибиторов протонной помпы (ИПП) 2 раза в сутки в течение 8 недель и наличии патологического гастроэзофагеального рефлюкса. Среди возможных механизмов, лежащих в основе рефрактерных к терапии ИПП симптомов, характерных для ГЭРБ, можно назвать сохранение патологического рефлюкса, гиперчувствительность пищевода к рефлюксу, связь симптомов с другими заболеваниями и функциональный характер симптомов. Для диагностики рефрактерной ГЭРБ проводят тщательный анализ симптомов, эзофагогастроскопию с морфологическим исследованием, рН-импедансометрию и манометрию пищевода. Лечение включает модификацию диеты и образа жизни для снижения массы тела у больных с ожирением, оптимизацию назначения ИПП, применение других препаратов и, по показаниям, хирургических методов.Заключение. Диагностика причин снижения эффективности ИПП у пациентов с ГЭРБ является сложным процессом, который требует применения современных эндоскопических методов с выполнением морфологического исследования пищевода, pH-импедансометрии и манометрии высокого разрешения для определения характера рефлюкса, связи рефлюкса с симптомами ГЭРБ и дифференциальной диагностики различных синдромов ГЭРБ. Выбор терапии пациентов с рефрактерной ГЭРБ определяется результатами обследования и заключительным диагнозом.</p></abstract><trans-abstract xml:lang="en"><p>Objective of the Review: To analyze current data on the diagnosis and treatment of refractory gastroesophageal reflux disease (GERD).Key points. Refractory GERD is diagnosed when there is insufficient response to proton pump inhibitors (PPIs) twice daily for 8 weeks with the presence of pathological gastroesophageal reflux. Possible mechanisms underlying PPI-refractory symptoms characteristic of GERD include persistence of pathological reflux, esophageal hypersensitivity to reflux, association of symptoms with other diseases, and functional nature of symptoms. To diagnose refractory GERD, a thorough analysis of symptoms, esophagogastroscopy with morphological examination, pH-impedancemetry and esophageal manometry are performed. Treatment includes dietary and lifestyle modifications to reduce body weight in obese patients, optimization of PPI prescribing, use of other drugs, and, if indicated, surgery.Conclusion. Diagnosing the reasons for the decrease in the effectiveness of PPIs in patients with GERD is a complex process that requires the use of modern endoscopic methods with the performance of a morphological study of the esophagus, pH-impedance testing and highresolution manometry to determine the nature of reflux, the relationship of reflux with symptoms of GERD and the differential diagnosis of various GERD syndromes. The choice of therapy for patients with refractory GERD is determined by the results of the examination and the final diagnosis.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>рефрактерная гастроэзофагеальная рефлюксная болезнь</kwd><kwd>ингибиторы протонной помпы</kwd><kwd>диагностика</kwd><kwd>лечение</kwd></kwd-group><kwd-group xml:lang="en"><kwd>refractory gastroesophageal reflux disease</kwd><kwd>proton pump inhibitors</kwd><kwd>diagnosis</kwd><kwd>treatment</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Eusebi L.H., Ratnakumaran R., Yuan Y., Solaymani-Dodaran M. et al. Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis. Gut. 2018; 67(3): 430–40. DOI: 10.1136/gutjnl-2016-313589</mixed-citation><mixed-citation xml:lang="en">Eusebi L.H., Ratnakumaran R., Yuan Y., Solaymani-Dodaran M. et al. 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