Labenz Joachim, Schoppmann Sebastian F
Refluxzentrum Siegerland, Siegen, Germany.
Medical Faculty of Duisburg-Essen University, Essen, Germany.
Commun Med (Lond). 2024 Oct 14;4(1):200. doi: 10.1038/s43856-024-00632-6.
Proton pump inhibitors (PPIs) are the main treatment recommended and used for gastro-esophageal reflux disease (GERD). However, they fail to control symptoms in a substantial proportion of patients who have PPI-refractory GERD, which is defined as persistent symptoms attributable to objective findings of gastro-esophageal reflux. There remains a lack of dedicated guidelines to direct the management of these patients, some of whom could benefit greatly from surgical treatment. Too often patients remain long-term on ineffective treatment or stop treatment with lack of active review often resulting in their dissatisfaction going unnoticed. Also, concerns over efficacy and side effects of surgical procedures can be off-putting for both patients and physicians. It has been suggested that response to PPIs is predictive of surgical outcome. In this Perspective article we instead recommend that the key determinant should be whether symptoms are caused by GERD. We also discuss the traditional and newer surgical treatment options for people with PPI-refractory GERD.
质子泵抑制剂（PPIs）是推荐用于治疗胃食管反流病（GERD）的主要药物。然而，在相当一部分患有质子泵抑制剂难治性GERD的患者中，这些药物无法控制症状。质子泵抑制剂难治性GERD被定义为因胃食管反流的客观表现而导致的持续性症状。目前仍缺乏专门指导这些患者管理的指南，其中一些患者可能从手术治疗中获益匪浅。患者常常长期接受无效治疗，或者在缺乏积极评估的情况下停止治疗，这往往导致他们的不满未被注意到。此外，对手术疗效和副作用的担忧可能会使患者和医生都望而却步。有人认为，对质子泵抑制剂的反应可预测手术结果。在这篇观点文章中，我们反而建议关键的决定因素应该是症状是否由GERD引起。我们还讨论了质子泵抑制剂难治性GERD患者的传统和新型手术治疗选择。
