Beyond PPIs: What is the Best Approach to Managing Refractory GERD?
JANUARY 18, 2013
The most pressing in managing gastroesophageal reflux disease (GERD) today is finding an effective approach to relieving refractory symptoms in patients on proton pump inhibitors, according to a specialist on the condition who spoke this week at a joint conference of the American Gastroenterological Association and the American Society for Gastrointestinal Endoscopy in Coronado, California.
A common condition, GERD is difficult to define but constitutes about 17 percent of all digestive disease diagnoses, said John Pandolfino, MD, professor of medicine, Gastroenterology and Hepatology, at the Feinberg School of Medicine at Northwestern University in Chicago. Proton pump inhibitors (PPI), which work by suppressing the production of stomach acids, are often prescribed to treat the condition. Although PPIs are considered to be effective treatment for GERD, 30-50% of patients complain that the medications do not adequately control their symptoms.
Almost everyone takes or has taken PPIs, said Pandolfino. However, some patients treated with PPI have refractory symptoms that cannot be controlled even with aggressive treatment. “The main clinical issue that we need to deal with in 2013 is refractory symptoms in patients on PPIs,” Pandolfino said.
The definition of refractory GERD is complex and confusing and patients who experience it are often referred to as PPI non-responders because they don’t improve with PPI treatment, said Pandolfino. But many patients who don’t respond to PPI treatment actually don’t have reflux; they may have other conditions, such as functional heartburn, that mimic but are not GERD, he said.