Université de Lyon, Hospices Civils de Lyon, Digestive Physiology, Hopital E Herriot, F-69437, Lyon, France; Université de Lyon, Lyon I University, Digestive Physiology, F-69008, Lyon, France; Université de Lyon, Inserm U1032, LabTAU, F-69008, Lyon, France.
Université de Lyon, Hospices Civils de Lyon, Digestive Physiology, Hopital E Herriot, F-69437, Lyon, France; Université de Lyon, Lyon I University, Digestive Physiology, F-69008, Lyon, France; Université de Lyon, Inserm U1032, LabTAU, F-69008, Lyon, France.
Curr Opin Pharmacol. 2018 Dec;43:99-103. doi: 10.1016/j.coph.2018.09.001. Epub 2018 Sep 18.
Pharmacologic therapy, surgery, minimally invasive therapies, and alternative therapies are different options available for the management of refractory GERD. The choice may depend on the cause of refractoriness. Increased gastric acid suppression therapy might be useful in the rare patients with persistent elevated esophageal acid exposure on proton pump inhibitors (PPI). Potassium-competitive acid blockers (P-CAB) might induce a more important acid inhibition than PPI. Baclofen might act as a reflux inhibitor and demonstrates a significant efficacy in rumination syndrome. The role of topical antacid-alginate in refractory GERD might be limited. Surgery might be a valid option in case of persistent pathological acid esophageal exposure despite PPI. Further evaluation of minimally invasive procedures is necessary. Finally diet, diaphragmatic breathing and transcutaneous electrical acustimulation might be of interest in patients with esophageal hypersensivity or functional symptoms.
药物治疗、手术、微创治疗和替代疗法是治疗难治性 GERD 的不同选择。选择可能取决于难治性的原因。对于质子泵抑制剂（PPI）持续升高食管酸暴露的极少数患者，增加胃酸抑制治疗可能是有用的。钾竞争性酸阻滞剂（P-CAB）可能比 PPI 产生更重要的酸抑制作用。巴氯芬可能作为反流抑制剂，在反刍综合征中显示出显著疗效。局部抗酸-藻酸盐在难治性 GERD 中的作用可能有限。对于尽管使用 PPI 仍持续存在病理性酸食管暴露的患者，手术可能是一种有效的选择。需要进一步评估微创程序。最后，对于食管高敏性或功能性症状的患者，饮食、膈式呼吸和经皮电刺激可能会引起兴趣。
