Persistent Reflux Symptoms in the Proton Pump Inhibitor Era: The Changing Face of Gastroesophageal Reflux Disease

摘要: Given the widespread use of potent acid suppressive therapies and primary caregivers’ increasing comfort with prescribing these medications at high doses, patient population presenting to gastroenterologists for symptoms gastroesophageal reflux disease (GERD) has changed. Whereas previous consultation often revolved around control erosive other mucosal manifestations GERD, terminated prescription proton pump inhibitor (PPI) therapy, now only enter scene after failure PPI either resistant or partially responsive medications. Because proportion subjects esophagitis who are healed PPI, 1,2 upper endoscopy such individuals is low yield, 3 a small minority demonstrating disease. The care patients challenging. High-quality evidence supporting useful diagnostic testing alternative effective largely lacking. However, number GERD incompletely nonresponsive high, their utilization healthcare resources substantial. purpose this mini-review examine definition epidemiology esophageal potential pathophysiologic mechanisms behind symptoms, differential diagnosis evaluation patients, current developing therapeutic options.