Universitatea de Stat de Medicină şi Farmacie "Nicolae Testemiţanu"
Abstract
The State University of Medicine and Pharmacy ”Nicolae Testemițanu”, Departament of gastroenterology
The State University of Medicine and Pharmacy ”Nicolae Testemițanu”, Departament of general surgery nr. 3
Clinic of Gastroenterology and Hepatology, Chisinau, Republic of Moldova, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareIntroduction. Refractory gastroesophageal reflux disease (rGERD) is defined as
the persistence of typical symptoms that do not respond to stable, twice-daily
proton pump inhibitors (PPI) dosing during at least 12 weeks of treatment. Up to
30% of GERD patients experience rGERD. The factors that can cause rGERD are
many and vary in incidence, clinical importance, symptom severity and frequency.
Purpose. The assessment of the patient with rGERD must be careful, detailed and
should be done step by step, considering that rGERD probable does not have a
single underlying cause and may actually describe several disease states.
Material and methods. A standard evaluation of rGERD symptoms should
include a thorough symptom evaluation, a structural and a functional evaluation of
the upper gastrointestinal tract. The symptom assessment include the
determination of persistent signs, aggravating factors and presence of alarm
symptoms. The instrumental work-up consists in barium swallow, upper GI
endoscopy, esophageal 24h pH- and impedance monitoring, esophageal Bilitec test
and high-resolution manometry (HRM).Results.The therapeutic approach of the patient with rGERD must be complex and
target several pathogenetic mechanisms. There are a myriad of potential therapies
that vary in efficacy, invasiveness and accessibility. Lifestyle modifications, such as
elevation of the head of the bed at night, weight loss and special diet remain to be
recommended as a first-line therapy for rGERD. Pharmacologic treatments include
optimization of PPI and associated with other medication, like as H2-blokers,
antacids, motility agents, antidepressants, reflux inhibitors, bile acid binder. In
some situation, we reccomend various endoscopic procedures or surgeries, such
as laparoscopic fundoplication. Nonpharmacologic interventions used in
treatment of rGERD include divers therapies: cognitive behavioral therapy,
hypnotherapy, biofeedback, alternative and complementary treatments, such as
acupuncture, herbal treatments (Rikkunshito) and transcutaneous electrical
acustimulation.Conclusion. Management of patients with rGERD is a major clinical challenge for
the gastroenterologist, and the multitude of potential therapies that vary in
efficacy, invasiveness, and accessibility need to be individualized for each patient