Modern achievements in the diagnosis and treatment of the refractory gastroesophageal reflux disease


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Abstract

Purpose of the review to present up-to-date data on the causes, methods of diagnosis and treatment of the refractory form of gastroesophageal reflux disease (GERD). Refractory GERD is the preservation of typical symptoms of the disease and/or incomplete healing of the esophageal mucosa against the background of taking a standard dose of proton pump inhibitors (PPI) once a day for 8 weeks. The reasons for the lack of response to the treatment are divided into related to the patient, related to therapy, and not related to GERD. Diagnostic approaches include x-ray examination of the esophagus and stomach, endoscopy with biopsy, 24-hour Impedance-pH monitoring, esophageal manometry. Depending on the reasons for the lack of response to the therapy, treatment may include lifestyle changes, doubling the dose of PPI, replacing PPI with another, adding H2-receptor antagonists, prokinetics, antacids, alginates and adsorbents. If conservative treatment is ineffective, it is possible to consider alternative methods, such as surgical treatment. Refractory GERD is a serious clinical problem. The absence of an answer to 8-week therapy with PPI requires a thorough differential diagnosis using additional examination methods. The identification of the causes of refractory to the therapy allows to optimize the approaches to its overcoming and to choose the optimal treatment.

About the authors

V T Ivashkin

I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University)

д.м.н., проф., акад. РАН, зав. каф. пропедевтики внутренних болезней и директор Клиники пропедевтики внутренних болезней, гастроэнтерологии и гепатологии им. В.Х. Василенко, Первый МГМУ им. И.М. Сеченова Moscow, Russia

I V Maev

A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia

акад. РАН, д.м.н., проф., зав. каф. пропедевтики внутренних болезней и гастроэнтерологии МГМСУ им. А.И. Евдокимова Moscow, Russia

A S Trukhmanov

I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University)

д.м.н., проф. каф. пропедевтики внутренних болезней Первого МГМУ им. И.М. Сеченова Moscow, Russia

D E Rumyantseva

I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University)

Email: diana-ryazanceva@yandex.ru
врач отделения гастроэнтерологии Клиники пропедевтики внутренних болезней, гастроэнтерологии и гепатологии им. В.Х. Василенко, Первый МГМУ им. И.М. Сеченова УКБ №2 Moscow, Russia

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