Modern Aspects of Diagnosis and Treatment of Refractory Gastroesophageal Reflux Disease
https://doi.org/10.31550/1727-2378-2022-21-6-35-40
Abstract
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.
About the Authors
V. V. Tsukanov
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”
Russian Federation
Russian Federation
3-g Partisan Zheleznyak Str., Krasnoyarsk, 660022
A.. V. Vasyutin
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”
Russian Federation
Russian Federation
3-g Partisan Zheleznyak Str., Krasnoyarsk, 660022
Yu L. Tonkikh
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”
Russian Federation
Russian Federation
3-g Partisan Zheleznyak Str., Krasnoyarsk, 660022
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Review
For citations:
Tsukanov V.V., Vasyutin A.V., Tonkikh Yu.L. Modern Aspects of Diagnosis and Treatment of Refractory Gastroesophageal Reflux Disease. Title. 2022;21(6):35-40. (In Russ.) https://doi.org/10.31550/1727-2378-2022-21-6-35-40
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