Division of Gastroenterology, Center for Esophageal Diseases, Baylor University Medical Center, Center for Esophageal Research, Baylor Scott & White Research Institute, 3500 Gaston Avenue, 2 Hoblitzelle, Suite 250, Dallas, TX 75246, USA.
Gastroenterol Clin North Am. 2020 Sep;49(3):437-450. doi: 10.1016/j.gtc.2020.04.003. Epub 2020 Jun 14.
Despite the exceptional efficacy of proton pump inhibitors (PPIs) in healing reflux esophagitis complicating gastroesophageal reflux disease (GERD), up to 40% of patients who take PPIs for GERD complain of persistent GERD symptoms. There is no clear consensus on the type, dosing, and duration of PPI therapy required to establish a diagnosis of PPI-refractory GERD symptoms, but most authorities do not consider patients "PPI-refractory" unless they have been on double-dose PPIs. This article discusses the mechanisms that might underlie heartburn that does not respond PPIs and an approach to the management of patients with PPI-refractory GERD symptoms.
尽管质子泵抑制剂 (PPI) 在治愈胃食管反流病 (GERD) 并发的反流性食管炎方面具有卓越的疗效，但仍有多达 40%的 GERD 患者在服用 PPI 后会持续出现 GERD 症状。目前对于明确诊断 PPI 难治性 GERD 症状所需的 PPI 治疗类型、剂量和持续时间尚无明确共识，但大多数权威机构认为，除非患者接受了双倍剂量的 PPI 治疗，否则不能将其视为“PPI 难治性”。本文讨论了可能导致 PPI 治疗无效的烧心症状的机制，并探讨了治疗 PPI 难治性 GERD 症状患者的方法。
