Introduction to Refractory Gerd

What is/are Refractory Gerd?

Refractory Gerd - Refractory GERD patients not responding to BID proton pump inhibitors are often referred for anti-reflux surgery. ^[1] Methods: Prospective randomized study of 46 pediatric patients with refractory GERD who underwent laparoscopic Nissen fundoplication divided into two equal groups. ^[2] We aimed to assess the safety, feasibility, and efficacy of a novel endoscopic resection and plication (RAP) anti-reflux procedure for management of medically refractory GERD in patients with altered gastric anatomy. ^[3] The panel conditionally recommended surgical treatment over medical management for adults with chronic or chronic refractory GERD. ^[4] Stretta can be considered in patients with PPI refractory GERD and might have a role in patients with reflux hypersensitivity and functional heartburn. ^[5] The first indication of Stretta is refractory GERD without definite hiatal hernia or GEFV grade IV. ^[6] Research on esophageal mucosal integrity in gastro-oesophageal reflux disease (GERD) has been taken seriously in recent years, especially in refractory GERD. ^[7] Transoral incisionless fundoplication (TIF2) and magnetic sphincter augmentation (MSA) are less invasive options for the treatment of refractory GERD and are increasingly gaining popularity. ^[8] We prospectively enrolled patients undergoing upper endoscopy for refractory GERD or non-GERD conditions. ^[9] We aimed to review the outcomes of STRETTA in patients with medically refractory GERD, who had undergone previous gastric surgery. ^[10] METHODS We performed an observational study of patients with refractory GERD who underwent EGD from 2013 to 2016 at a tertiary hospital. ^[11] GOALS To update the estimate of the prevalence of refractory gastroesophageal reflux disease (GERD) in the United States, and to assess the clinical and economic differences between patients with and without refractory GERD. ^[12] Causes of acquired long-segment esophageal disruption include recurrent leaks and fistulae after primary repair, refractory GERD, caustic ingestions, cancer, and strictures. ^[13] Here, we evaluate the efficacy and acceptability of partial fundoplication for the treatment of medically refractory GERD in patients with scleroderma. ^[14] Therefore, management of refractory GERD in this population remains challenging. ^[15] Here, we investigated the potential role of RvD1 in acid-induced DNA damage in esophageal epithelial cells, patients with refractory GERD and a rat model of acid reflux. ^[16] Conclusions  Post-POEM, PPI-refractory GERD is rare. ^[17] The Dor fundoplication performed for refractory GERD in SSc patients substantially decreases heartburn and regurgitation, primarily nocturnal, without affecting dysphagia, thus improving the quality of life. ^[18] In a subsequent exploratory study, saliva was collected from 34 patients with continuing GERD symptoms despite PPI treatment (refractory GERD), 30 healthy subjects, and 30 PPI-controlled GERD patients at ≥4 hours postmeal. ^[19] We investigated the efficacy of a low FODMAPs diet in patients with PPI refractory GERD. ^[20] In refractory GERD, optimization of proton-pump inhibitor treatment should be attempted before a series of diagnostic tests to assess the patient’s phenotype. ^[21] We believe that due to bile content, alternative therapeutic strategies using specific inhibitors of relevant molecular pathways or receptors may be considered in patients with refractory GERD. ^[22] Although lifestyle and diet modification and proton-pump inhibitors (PPIs) remain the standard of therapy, approximately 30% of patients experience persistent or recurrent symptoms with this therapy, which has been labeled PPI-refractory GERD. ^[23] Noteworthy is that the majority of the alleged PPI-refractory GERD patients do not, after careful investigations, have GERD. ^[24] To be eligible for the procedure, patients required medically refractory GERD and a hiatal hernia no more than 2 cm. ^[25] Background and aims Endoscopic therapy of gastroesophageal reflux disease (GERD) overcomes the “treatment gap” for patients with refractory GERD, who are not willing to go into surgery. ^[26] This review will identify the fundoplication approach for chronic or refractory GERD that provides better reflux control with minimal post-procedure complications. ^[27] Finally, we will discuss findings from our laboratory where we identified an active gastric vacuolar H(+)-ATPase as a putative mechanism for refractory GERD. ^[28] Surgeons should approach patients with a competent GEJ and medically refractory GERD with caution. ^[29] We aim to investigate the treatment pattern and economic burden in Korea of refractory GERD requiring long-term use of proton pump inhibitors (PPIs). ^[30] METHODS Between March 2013 and November 2018, a total of 73 refractory GERD patients (34 in the conventional PPI group versus 39 in the vonoprazan group) were enrolled in this retrospective study. ^[31] This study aimed to evaluate the efficacy of combination of PPI with domperidone (a prokinetic agent) compared with PPI alone in the treatment of patients with refractory GERD. ^[32] Conclusion: In patients with PPI-refractory GERD, VPZ provides more potent gastric acid suppression, more effective EAE control, enhanced symptom improvement, and better esophagitis healing than PPIs. ^[33] Fundoplication is not an option, and medically refractory GERD after LSG is usually treated with conversion to RYGB. ^[34] Finally, we will discuss findings from our laboratory where we identified an active gastric vacuolar H+-ATPase as a putative mechanism for refractory GERD. ^[35] We performed a multicenter, randomized, parallel-group exploratory trial to determine the efficacy of hangeshashinto (HST) in patients with PPI-refractory GERD. ^[36] It is also feasible in patients with refractory GERD following gastric/bariatric surgery. ^[37] Our purpose was to assess the efficacy of TIF in patients with chronic refractory GERD in controlling heartburn, regurgitation, dysphagia or atypical symptoms using quality of life questionnaire and scoring system that assesses laryngopharyngeal reflux (LPR). ^[38] Refractory GERD symptoms have been identified in 10-40% of patients with GERD who are treated with PPIs. ^[39] With this background, we held a consensus meeting to discuss the pathophysiology and management of GERD after POEM based on published papers and experiences of each expert and to discuss the prevention of GERD and dealing with anti-acid drug refractory GERD. ^[40] Given the significant effect of GERD on quality of life, further research and development of new therapies are needed for patients with PPI-refractory GERD symptoms. ^[41] In this study, we evaluated the serum GIP and PP levels in refractory GERD patients and analyzed their metabolic and motility characteristics. ^[42] This article reviews the definition, mechanisms, and management options for PPI-refractory GERD. ^[43] Conclusion Combining mosapride for four weeks with a standard dose of PPI is not more effective than PPI alone in patients with PPI-refractory GERD. ^[44] As such, the term refractory GERD, which has traditionally referred to persistence of mucosal disease in spite of proton pump inhibitor (PPI) therapy, has now evolved to define failure of symptomatic response for potential GERD symptoms. ^[45] In the Philippines, there is no local data on the yield of these tests in the investigation of the patients with suspected refractory GERD as well as on the phenotypic profiles of Filipino patients being referred for esophageal reflux monitoring. ^[46] METHODS A clinical team conducted a quality improvement study in which a nurse practitioner (NP) navigator performed a preconsultation chart review for patients with refractory GERD referred to an Esophagus Center between August and December 2018. ^[47] Patients with refractory GERD were recruited for a nonrandomized concurrent comparison, with 60 patients in the C-BLART with tailored PPI use group and 43 patients in the BID proton pump inhibitor (PPI) group. ^[48] ConclusionMII-pH testing on medications in patients with refractory GERD symptoms does not reliably correlate with a diagnosis of GERD as defined by pathologic esophageal acid exposure off medications. ^[49] Refractory GERD, symptoms due to gastric stricture, and comorbidities all improved after the revisional surgery. ^[50]

Medically Refractory Gerd

We aimed to assess the safety, feasibility, and efficacy of a novel endoscopic resection and plication (RAP) anti-reflux procedure for management of medically refractory GERD in patients with altered gastric anatomy. ^[1] We aimed to review the outcomes of STRETTA in patients with medically refractory GERD, who had undergone previous gastric surgery. ^[2] Here, we evaluate the efficacy and acceptability of partial fundoplication for the treatment of medically refractory GERD in patients with scleroderma.