Michele Cicala, Sara Emerenziani, Michele Pier Luca Guarino, Mentore Ribolsi, Unit of Digestive Disease, Campus Bio Medico University of Rome, 00128 Rome, Italy.
World J Gastroenterol. 2013 Oct 21;19(39):6529-35. doi: 10.3748/wjg.v19.i39.6529.
Gastro-esophageal reflux disease (GERD) is one of the most prevalent chronic diseases. Although proton pump inhibitors (PPIs) represent the mainstay of treatment both for healing erosive esophagitis and for symptom relief, several studies have shown that up to 40% of GERD patients reported either partial or complete lack of response of their symptoms to a standard PPI dose once daily. Several mechanisms have been proposed as involved in PPIs resistance, including ineffective control of gastric acid secretion, esophageal hypersensitivity, ultrastructural and functional changes in the esophageal epithelium. The diagnostic evaluation of a refractory GERD patients should include an accurate clinical evaluation, upper endoscopy, esophageal manometry and ambulatory pH-impedance monitoring, which allows to discriminate non-erosive reflux disease patients from those presenting esophageal hypersensitivity or functional heartburn. Treatment has been primarily based on doubling the PPI dose or switching to another PPI. Patients with proven disease, not responding to PPI twice daily, are eligible for anti-reflux surgery.
胃食管反流病（GERD）是最常见的慢性疾病之一。质子泵抑制剂（PPIs）是治疗糜烂性食管炎和缓解症状的主要药物，但多项研究表明，高达 40%的 GERD 患者报告称，其症状对标准剂量的 PPI 每日一次治疗反应不完全或无反应。已经提出了几种与 PPI 耐药相关的机制，包括胃酸分泌控制无效、食管高敏性、食管上皮的超微结构和功能改变。难治性 GERD 患者的诊断评估应包括准确的临床评估、上消化道内镜检查、食管测压和动态 pH 阻抗监测，这有助于将非糜烂性反流病患者与食管高敏性或功能性烧心患者区分开来。治疗主要基于将 PPI 剂量加倍或改用另一种 PPI。对于每天两次 PPI 治疗仍未缓解的患者，可考虑进行抗反流手术。
