Gastroesophageal reflux disease, refractory to treatment with proton pump inhibitors

Treatment of gastroesophageal reflux disease (GERD) is an urgent problem of modern gastroenterology. According to numerous studies carried out from 2000 to 2011, the prevalence of GERD varies depending on the region of the world from 2.5% (in East Asia) to 33.1% (in the Middle East). Moreover, according to various authors, the rate of failure of GERD therapy can reach 40%. Today there is no general accepted definition of “refractoriness” in all professional communities. In the clinical guidelines for the diagnosis and treatment of GERD of the Russian Gastroenterological Association (RGA), refractoriness is understood as the persistence of typical symptoms of the disease and/or incomplete healing of the esophageal mucosa while taking a standard dose of proton pump inhibitors (PPIs) once a day for 8 weeks. It should be noted that it is legitimate to talk about the refractory form of GERD in the case when the diagnosis of GERD was verified according to current clinical recommendations, treatment was prescribed according to the identified phenotype of the disease, but the therapy administered to the patient is accompanied by a partial effect. The article presents the basic principles of treatment a patient with gastroesophageal reflux disease refractory to proton pump inhibitor therapy. An algorithm for identifying and eliminating possible causes of refractoriness is proposed, taking into account the phenotype of the disease and the presence of concomitant pathology.

gastroesophageal reflux disease, refractoriness, compliance in treatment, proton pump inhibitors, prokinetics, ursodeoxycholic acid, rebamipide

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