Functional gastroesophageal reflux disease (GERD)
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Lack of endoscopic esophagitis does not exclude gastroesophageal reflux disease (GERD).
Ambulatory pH testing is also an imperfect standard, and patients with both a normal endoscopy and a normal pH test may still have symptoms produced by acid reflux.
A therapeutic trial of acid suppression is often the best approach to these patients.
Ideally, therapeutic trials should use a medication with a high degree of efficacy in the treatment of GERD to avoid a false-negative test.
Proton pump inhibitors (PPIs) are the best currently available medical therapy for all forms of GERD.
If the patient does not respond to a once daily PPI, options include increasing the dose of PPIs, and, perhaps, adding another class of agent or studying the patient with an ambulatory pH test.
Patients with a negative endoscopy, negative pH test. and those who do not respond to an adequate trial of acid suppression are unlikely to benefit from antireflux surgery.
KeywordsIrritable Bowel Syndrome Omeprazole Esophagitis Cisapride Gastroesophageal Reflux Disease
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References and Recommended Reading
- 2.Lauritsen K, Aalykke C, Havelund T, et al.: Effect of omeprazole in functional dyspepsia: a double-blind, randomized, placebo-controlled study. Gastroenterology 1996, 110:A702.Google Scholar
- 9.Bradley LA, Richter JE, Pulliam TJ, et al.: The relationship between stress and symptoms of gastroesophageal reflux: the influence of psychological factors. Am J Gastroenterol 1993, 8:11–19.Google Scholar
- 12.Watson RG, Tham TC, Johnston BT, McDougall NI: Double blind cross-over placebo controlled study of omeprazole in the treatment of patients with reflux symptoms and physiological levels of acid reflux: the sensitive esophagus. Gut 1997, 40:587–590. The above study is an important trial of acid suppression in a group of patients with reflux symptoms without endoscopic or pH abnormalities. This study indicated that many of these patients will respond to reflux therapy.PubMedGoogle Scholar
- 15.Smart HL, Nicholson DA, Atkinson M: Gastro-oesophageal reflux in the irritable bowel syndrome. Gut 1986, 27:1227–1131.Google Scholar
- 35.Weerts JM, Dallemagne B, Harmoir E, et al.: Laparoscopic Nissen Fundoplication: Detailed analysis of 132 patients. Surg Laprosc Endosc 1993, 3:359–364.Google Scholar
- 36.Bammer T, Freeman M, Shahriare A, et al.: The surgical outcome of laparoscopic anti-reflux surgery in patients with endoscopy negative gastroesophageal reflux disease. Gastroenterology 1998, 116:A107.Google Scholar