Division of Gastroenterology, Hepatology, and Nutrition, Center for Swallowing and Esophageal Disorders, Vanderbilt University Medical Center, C2104-MCN, Nashville, TN, USA.
Expert Rev Gastroenterol Hepatol. 2014 Aug;8(6):657-67. doi: 10.1586/17474124.2014.910454. Epub 2014 Apr 19.
'Refractory gastroesophageal reflux disease' is one of the most common misnomers in the area of gastroesophageal reflux disease. The term implies reflux as the underlying etiology despite unresponsiveness to aggressive proton pump inhibitor therapy. The term should be replaced with 'refractory symptoms.' We must acknowledge that in many patients symptoms of reflux often overlap with non-GERD causes such as gastroparesis, dyspepsia, hypersensitive esophagus and functional disorders. Lack of response to aggressive acid suppressive therapy often leads to diagnostic testing. In majority of patients these tests are normal. The role of non-acid reflux in this group is uncertain and patients should not undergo surgical fundoplication based on this parameter. In patients unresponsive to acid suppressive therapy GERD is most commonly not causal and a search for non-GERD causes must ensue.
“难治性胃食管反流病”是胃食管反流病领域最常见的错误命名之一。该术语暗示反流是潜在病因，尽管对抗质子泵抑制剂治疗无反应。该术语应替换为“难治性症状”。我们必须承认，在许多患者中，反流症状常常与非 GERD 原因重叠，如胃轻瘫、消化不良、食管高敏和功能性障碍。对积极的抑酸治疗无反应常导致诊断性检查。在大多数患者中，这些检查都是正常的。在这组患者中，非酸性反流的作用尚不确定，不应该仅仅基于这一参数就对患者行手术胃底折叠术。对于抑酸治疗无反应的患者，GERD 通常不是病因，必须寻找非 GERD 病因。
