Possibilities of pH impedance and high-resolution manometry in managing patients with refractory gastroesophageal reflux disease


Cite item

Full Text

Abstract

Gastroesophageal reflux disease (GERD) is a common condition that has a substantial impact on quality of life in patients and is a leading risk factor for esophageal adenocarcinoma. Now therapy with proton pump inhibitors (PPIs) is a basic method in the treatment of patients with GERD; however, one third of the patients do not respond to the therapy used. The causes of refractory GERD are a fairly large group of heterogeneous factors contributing to the inefficacy of PPIs in adequate dosage. Among these factors, there is low compliance by patients to the prescribed treatment regimen; nocturnal acid breakthrough; СУР2С19 gene polymorphism; chiasm syndrome with functional diseases of the gastrointestinal tract; non-acidic refluxes in a patient; thoracic esophageal motility disorders; the increased number and duration of transient lower esophageal sphincter relaxation periods; hiatus hernia; and misdiagnosis. 24-hour pH impedance and high-resolution esophageal manometry are now the most informative diagnostic techniques in patients who fail to respond to PPI therapy. These techniques allow one to timely recognize the causes of refractory GERD, to make a differential diagnosis with other nosological entities, and to timely correct therapy for each individual patient.

About the authors

I V Maev

Московский государственный медико-стоматологический университет им. А.И. Евдокимова Минздрава России

Москва, Россия

E V Barkalova

Московский государственный медико-стоматологический университет им. А.И. Евдокимова Минздрава России

Москва, Россия

M A Ovsepyan

Московский государственный медико-стоматологический университет им. А.И. Евдокимова Минздрава России

Москва, Россия

Yu A Kucheryavyi

Московский государственный медико-стоматологический университет им. А.И. Евдокимова Минздрава России

Москва, Россия

D N Andreev

Московский государственный медико-стоматологический университет им. А.И. Евдокимова Минздрава России

Москва, Россия

References

  1. Абу Али ибн Сина (Авиценна). Канон врачебной науки. Изд. ЭНИО; 2003.
  2. Rossetti M. The reflux disease of the esophagus--clinical-surgical aspects. Hippokrates. 1967;38(3):92-97.
  3. Dent J, Brun J, Fendrick M, Fennerty J, Janssens P, Kahrilas K, Lauritsen J, Reynolds M, Shaw N. Talley on behalf of the Genval Workshop Group An evidence-based appraisal of reflux disease management-the Genval Workshop Report. Gut 1999;44(suppl 2):S1—S16. doi: 10.1136/gut.44.2008.S1
  4. Vakil N, Zanten S, Kahrilas P, Dent J, Jones R. Global Consensus Group The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101(8):1900-1920. doi: 10.1111/j.1442-2050.2011.01271.x
  5. Ивашкин В.Т., Маев И.В., Трухманов А.С., Баранская Е.К., Дронова О.Б., Зайратьянц О.В., Пасечников В.Д., Сайфутдинов Р.Г., Шептулин А.А., Кучерявый Ю.А., Лапина Т.Л., Сторонова О.А., Кайбышева В.О. Гастроэзофагеальнаярефлюкснаяболезнь. Клинические рекомендации. Москва, 2014.
  6. Ивашкин В.Т., Маев И.В., Трухманов А.С. Пищевод Баррета. В двух томах. М.: Издательство «Шико»; 2011.
  7. Dent J. Endoscopic grading of reflux oesophagitis: the past, present and future. Best Pract Res Clin Gastroenterol. 2008;22(4):585-599. doi: 10.1016/j.bpg.2008.01.002
  8. th United European Gastroenterology Week. Birmingham, United Kingdom, 18-23 October 1997. Abstracts. Gut. 1997;41(Suppl 3):A1-258,E1-61.
  9. El-Serag H, Sweet S, Winchester C, Dent J. Update on the epidemiology of gastro- oesophageal reflux disease: a systematic review. Gut 2014;63:871-880. doi: 10.1136/gutjnl-2012-304269
  10. Лазебник Л.Б., Машарова А.А., Бордин Д.С., Васильев Ю.В., Ткаченко Е.И., Абдулхаков Р.А. Результаты мультицентрового исследования «Эпидемиология гастроэзофагеальной рефлюксной болезни в России» (МЕГРЕ). Тер. архив 2011;83:45-50.
  11. Bor S, Lazebnik L, Kitapcioglu G, Manannikof I, Vasiliev Y. Prevalence of gastroesophageal reflux disease in Moscow. DisEsophagus. 2016;29(2):159-165. doi: 10.1111/dote.12310
  12. Кайбышева В.О., Кучерявый Ю.А., Трухманов А.С., Сторонова О.А., Коньков М.Ю., Маев И.В., Ивашкин В.Т. Результаты многоцентрового наблюдательного исследования по применению международного опросника Gerd Q для диагностики ГЭРБ. РЖГГК. 2013;5:15-23.
  13. Zerbib F, Roman S, Ropert A, des Varannes SB, Pouderoux P, Chaput U, Mion F, Vérin E, Galmiche JP, Sifrim D. Esophageal pH-impedance monitoring and symptom analysis in GERD: a study in patients off and on therapy. Am J Gastroenterol. 2006;101(9):1956-1963. doi: 10.1111/j.1572-0241.2006.00711.x
  14. Fujiwara Y, Higuchi K, Yamamori K, Watanabe Y, Shiba M, Watanabe T, Tominaga K, Oshitani N, Matsumoto T, Arakawa T. Pathogenesis and treatment of refractory gastroesophageal reflux disease in Japanese patients Nihon Rinsho. 2004;62(8):1510-1515.
  15. Carlsson R, Dent J, Watts R, Riley S, Sheikh R, Hatlebakk J, Haug K, de Groot G, van Oudvorst A, Dalväg A, Junghard O, Wiklund I. Gastroesophageal reflux disease in primary care: an international study of different treatment strategies with omeprazole. International GORD Study Group. Eur J Gastroenterol Hepatol. 1998;10(2):119-124.
  16. Crawley J, Schmitt C. How satisfied are chronic heartburn sufferers with their prescription medications? Results of the Patient Unmet Needs Study. J Clin Outcomes Manag. 2000;7:29-34.
  17. Inadomi JM, McIntyre L, Bernard L, Fendrick AM. Stepdown from multipleto single-dose proton pump inhibitors (PPIs): a prospective study of patients with heartburn or acid regurgitation completely relieved with PPIs. Am J Gastroenterol. 2003;98(9):1940-1944. doi: 10.1111/j.1572-0241.2003.07665.x
  18. Cicala M, Emerenziani S, Guarino MP, Ribolsi M. Proton pump inhibitor resistance, the real challenge in gastroesophageal reflux disease. World J Gastroenterol 2013;19(39):6529-6535. doi: 10.3748/wjg.v19.i39.6529
  19. Scarpignato C. Poor effectiveness of proton pump inhibitors in non-erosive reflux disease: the truth in the end! Neurogastroenterol Motil. 2012;24(8):697-704. doi: 10.1111/j.1365-2982.2012.01977.x
  20. Kawami N, Iwakiri K, Sakamoto C. Pathophysiology and Treatment of PPI-resistant NERD. Nihon Rinsho. 2015;73(7):1197-1201.
  21. Chey WD, Inadomi JM, Booher AM, Sharma VK, Fendrick AM, Howden CW. Primary-care physician’s perceptions and practices on the management of GERD: results of a national survey. Am J Gastroenterol. 2005;100(6):1237-1242. doi: 10.1111/j.1572-0241.2005.41364.x
  22. Pezanoski J, Guanaratnam N, Cowen M. Correct and incorrect dosing of proton pump inhibitors and its impact on GERD symptoms. Gastroenterology. 2003;124(suppl.):128.
  23. Peres de la Serna J, Ruiz de Leon A, Sevilla-Mantilla C. Acid breakthrough in GERD patients under proton pump inhibitors (PPI) treatment in a daily practice. Gut. 2007;56(suppl. 3):217.
  24. Bredenoord A, Smout A. Therapy resistance of gastro-oesophageal reflux symptoms: acid reflux, non-acid reflux or no reflux. Ned Tijdschr Geneeskd. 2008;152(47):2548-52.
  25. Кучерявый Ю.А. Влияние полиморфизма гена CYP2С19 на эффективность эрадикационной терапии инфекции Helicobacter pylori. Экспер. иклин. гастроэнтерол. 2009;4:128-132.
  26. Маев И.В., Оганесян Т.С., Момыналиев К.Т., Кучерявый Ю.А., Белый П.А. Полиморфизм гена цитохрома Р-450 2C19 и лечение инфекции Helicobacter pylori. Экспер. иклин. гастроэнтерол. 2008;3:78-85.
  27. Ichikawa H, Sugimoto M, Sugimoto K, Andoh A Furuta T. Rapid metabolizer genotype of CYP2C19 is a risk factor of being refractory to proton pump inhibitor therapy for reflux esophagitis. J Gastroenterol Hepatol. 2016;31(4):716-726. doi: 10.1111/jgh.13233
  28. Maev IV, Andreev DN, Kucheryavyi YuA, Dicheva DT. Host factors influencing the eradication rate of Helicobacter pylori. World Applied Sciences Journal. 2014;30:134-40. doi: 10.5829/idosi.wasj.2014.30.mett.61
  29. Маев И.В., Самсонов А.А., Андреев Д.Н. Клиническое значение синдрома «перекреста» функциональной диспепсии и гастроэзофагеальной рефлюксной болезни. Клин. перспективыгастроэнтерологии, гепатологии. 2013;5:17-22.
  30. Rasmussen S, Jensen T, Henriksen S, Haastrup P, Larsen P, Sondergaard J, Jarbol D. Overlap of symptoms of gastroesophageal reflux disease, dyspepsia and irritable bowel syndrome in the general population. Scand J Gastroenterol. 2015;50(2):162-169. doi: 10.3109/00365521.2014.983157
  31. Young W, Hye-Kyung J, Seong-Eun K, Sung-Ae J. Overlap of Erosive and Non-erosive Reflux Diseases With Functional Gastrointestinal Disorders According to Rome III Criteria. J Neurogastroenterol Motil, 2010;16(2):148-156. doi: 10.5056/jnm.2010.16.2.148
  32. Hsu C, Liu T, Wen S, Wang C, Yi C, Chen J, Lei W, Orr W, Fabio P, Chen C. Clinical, metabolic, and psychological characteristics in patients with gastroesophageal reflux disease overlap with irritable bowel syndrome. Eur J Gastroenterol Hepatol. 2015;27(5):516-522. doi: 10.1097/MEG.0000000000000334
  33. Rieder F, Biancani P, Harnett K, Yerian L, Falk GW. Inflammatory mediators in gastroesophageal reflux disease: impact on esophageal motility, fibrosis, and carcinogenesis Am J Physiol Gastrointest Liver Physiol. 2010;298(5):G571-G581. doi: 10.1152/ajpgi.00454.2009
  34. Cicala M. Gastroesophageal reflux disease: Update on inflammation and symptom perception. World J Gastroenterol. 2013; 19(39):6523-6528. doi: 10.3748/wjg.v19.i39.6523
  35. Herregods T, Troelstra M, Weijenborg P, Bredenoord A, Smout A. Patients with refractory reflux symptoms often do not have GERD. Neurogastroenterol Motil. 2015;27(9):1267-1273. doi: 10.1111/nmo.12620
  36. Маев И.В., Андреев Д.Н., Дичева Д.Т Гастроэзофагеальная рефлюксная болезнь: от патогенеза к терапевтическим аспектам. Consillium medicum. 2013;15(8):30-34.
  37. Трухманов А.С., Кайбышева В.О. рН-импедансометрия пищевода. Пособие для врачей. Под ред. акад. РАМН, проф. В.Т. Ивашкина М.: ИД «МЕДПРАКТИКА-М»; 2013.
  38. Yinan S, Xiao Y, Chen M. Predictors for proton pump inhibitor failure in non-erosive gastroesophageal reflux disease. J Gastroenterol Hepatol. 2013;28(suppl. 3):60.
  39. Андреев Д.Н., Кучерявый Ю.А. Перспективы лечения гастроэзофагеальной рефлюксной болезни. Consilium Medicum. Гастроэнтерология. 2013;2:9-14.
  40. Кайбышева В.О., Трухманов А.С., Ивашкин В.Т. Обсуждение проблемы гастроэзофагеальной рефлюксной болезни в материалах Всемирного гастроэнтерологического конгресса (Шанхай, 2013). РЖГГК. 2014;24(3):22-27.
  41. Eun H, Lee D, Park K. Evaluation of efficacy of proton pump inhibitors in refractory gastroesophageal reflux disease. J Gastroenterol Hepatol. 2013;28(suppl. 3):290.
  42. Mainie I, Tutuian R, Shay S, Vela M, Zhang X, Sifrim D, Castell DO. Acid and nonacid reflux in patients with persistent symptoms despite acid suppressive therapy. A multicentre study using combined ambulatory impedance-pH monitoring. Gut. 2006;55(10):1398-1402. doi: 10.1136/gut.2005.087668
  43. Katz PO, Gerson LB, Vela MF. Diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 2013;108:308-328. doi: 10.1038/ajg.2012.444
  44. Sifrim D, Castell D, Dent J, Kahrilas PJ. Gastroesophageal reflux monitoring: Review and consensus report on detection and definitions of acid, non-acid, and gas reflux. Gut. 2004;53(7):1024-1031. doi: 10.1136/gut.2003.033290
  45. Aziz Q, Fass R, Gyawali C, Miwa H, Pandolfino J, Zerbib F. Functional Esophageal Disorders. Gastroenterology 2016;150:1368-1379. doi: 10.1053/j.gastro.2016.02.012
  46. Евсютина Ю.В., Трухманов А.С. Алгоритм ведения пациентов с рефрактерной формой ГЭРБ. РМЖ. 2015;28:1682-1683.
  47. Savarino E, Zentilin P, Tutuian R, Pohl D, Gemignani L, Malesci A, Savarino V. Impedance-pH reflux patterns can differentiate non-erosive reflux disease from functional heartburn patients. J Gastroenterol. 2012;47:159-168. doi: 10.1007/s00535-011-0480-0
  48. Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, Pandolfino JE. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil 2015;27:160-174. doi: 10.1111/nmo.12477
  49. Wang K, Duan L, Xia Z, Xu Z, Ge Y. Esophageal motility characteristics of refractory heartburn: a study based on high resolution manometry and 24 hour pH-impedance monitoring. Zhonghua Yi Xue Za Zhi. 2014;94(34):2650-2655.
  50. Boeckxstaens G. Alterations confined to the gastro-oesofageal junction: the relationship between low LOSP, TLOSRs, hiatus hernia and acid pocket. Best Practice and Research Clinical Gastroenterology. 2010;24:821-829. doi: 10.1016/j.bpg.2010.08.011
  51. Pandolfino JE, Zhang QG, Ghosh SK, Han A, Boniquit C, Kahrilas PJ. Transient lower esophageal sphincter relaxations and reflux: mechanistic analysis using concurrent fluoroscopy and high-resolution manometry. Gastroenterology. 2006;131:1725-1733. doi: 10.1053/j.gastro.2006.09.009
  52. Grossi L, Ciccaglione A, Travaglini N, Marzio L. Transient lower esophageal sphincter relaxations and gastroesophageal reflux episodes in healthy subjects and GERD patients during 24 hours. Dig Dis Sci. 2001;46(4):815-821.
  53. Bredenoord A, Weusten B, Carmagnola S, Smout A. Double-peaked high-pressure zone at the esophagogastric junction in controls and in patients with a hiatal hernia: a study using high-resolution manometry. Dig Dis Sci. 2004;49(7-8):1128-1135.
  54. Andolfi C, Bonavina L, Kavitt R, Konda V, Asti E, Patti M. Importance of Esophageal Manometry and pH Monitoring in the Evaluation of Patients with Refractory Gastroesophageal Reflux Disease: A Multicenter Study. J Laparoendosc Adv Surg Tech. A. 2016 May 24. [Epub ahead of print]. doi: 10.1089/lap.2016.0189

Copyright (c) 2017 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies