HCPLive Network

Beyond PPIs: What is the Best Approach to Managing Refractory GERD?

 
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.


Further Reading
As more studies have demonstrated potential therapeutic applications for marijuana, public opinion regarding medical and recreational marijuana use has shifted. One such study recently published in the American Journal of Gastroenterology revealed medical marijuana is potentially beneficial for digestive disorders and gastrointestinal symptoms.
Enterovirus-D68 could soon be in the rearview mirror, according to a Hartford, CT, pediatric intensivist who has treated more than 20 children hospitalized with the infection. “We may have plateaued,” said Christopher Carroll, MD, an asthma specialist at Connecticut Children’s Medical Center. While children are still being admitted for respiratory problems, “Now it’s more a mix of symptoms, not those of classic enterovirus.” Though he could not say for certain the outbreak has peaked, he did say that “things are not continuing to get worse.”
The World Health Organization continued its efforts to battle the ongoing Ebola outbreak with a second meeting of its Emergency Committee tackling the virus.
Counseling at-risk teens and adults to change risky behavior is an effective way to reduce the spread of sexually transmitted diseases, according to the US Preventive Services Task Force (USPSTF). The group is updating its guidelines for primary care physicians to recommend they offer appropriate patients such behavioral advice. The task force also calls for routine screening for chlamydia and gonorrhea for sexually active teens and women up to age 24. Older women who are pregnant or may be at risk of infection due to a variety of sexual behaviors—such as having multiple partners or exchanging sex for money or drugs—should also be screened, the USPSTF said.
Advances in knowledge surrounding gastrointestinal conditions have paved the way for improvements in Crohn’s disease (CD) treatment. To aid clinicians in managing patients with CD, the American Gastroenterological Association (AGA) created a clinical decision tool to effectively guide gastroenterologists throughout their decision-making process.
Smokers with cancer who used e-cigarettes along with traditional cigarettes were more dependent on nicotine than those who didn't use the devices, a Memorial Sloan Kettering study found. These patients were also just as likely -- or less likely -- to have quit smoking than patients who didn't use e-cigarettes.
The American Academy of Pediatrics has updated their influenza vaccine recommendations and is urging vaccination for everyone 6 months of age and older. The recommendations were published online Sept. 22 in Pediatrics.
More Reading
As more studies have demonstrated potential therapeutic applications for marijuana, public opinion regarding medical and recreational marijuana use has shifted. One such study recently published in the American Journal of Gastroenterology revealed medical marijuana is potentially beneficial for digestive disorders and gastrointestinal symptoms.