John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive


Gastro-esophageal reflux disease: What to do when PPIs fail? Volume 28, issue 8, Octobre 2021


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CHU de Bordeaux, Service d’hépato-gastroentérologie et oncologie digestive, Centre Médico-chirurgical Magellan, Avenue de Magellan, 33600 Pessac
* Correspondance

If PPIs represent the first line therapy of gastro-esophageal reflux symptoms, 30 to 40% of patients fail to achieve adequate symptom relief. Physicians have to check for treatment compliance, optimize anti-secretory therapy, and then perform endoscopic and functional investigations to: 1) demonstrate the presence of baseline GERD off therapy, and 2) in case of proven GERD, demonstrate that persisting symptoms are related to ongoing pathological GERD on therapy (refractory GERD). Diagnostic criteria of GERD and refractory GERD have been proposed by international experts consensus. A patient with true refractory GERD should be proposed a surgical approach (fundoplication) since medical and endoscopic alternatives are scarce, at least in France. If no GERD is present, atypical/extra-esophageal symptoms should be referred for specialized investigations. Functional esophageal symptoms (i.e. not related to GERD) may benefit from pain modulators.