Analysis on the Causes for Refractory GERD

• Published in: Journal of Huazhong University of Science and Technology. Medical sciences Vol. 22; no. 1; pp. 47 - 49
• Main Authors: Chen, Jie, Xu, Junying, Xu, Yong, Xie, Xiaoping, Yi, Cuiqiong, Hou, Xiaohua
• Format: Journal Article
• Language: English
• Published: China Department of Gastroenterology, Xiehe Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022 2002
• Subjects: Adult; Barrett Esophagus - complications; cause; Esophagitis - complications; Esophagitis - microbiology; Female; Gastroesophageal Reflux - complications; Gastroesophageal Reflux - diagnosis; Gastroesophageal Reflux - therapy; GERD; Helicobacter Infections - complications; Helicobacter pylori; Humans; Male; Middle Aged; refractory; Treatment Failure; GERD; refractory; cause
• ISSN: 1672-0733; 1993-1352
• DOI: 10.1007/BF02904787

To analyze the causes of failure in conventional treatment to refractory gastroesophageal reflux diseases (GERD) patients, 16 refractory GERD patients (group R) and 16 eases of GERD primarily diagnosed (group P) were studied. Endoscopy, pathologic examination and 14C urea breath test were conducted in every patient. 24 h ambulatory pH and bilirubin monitoring were performed with Digitrapper MI Ⅲ and Synetics Bilitec 2000. It was found that esophagitis in group R was more severe than in group P. The rate of Helicobacter pylori infection in group R was significantly lower than in group P. Fraction time pH below 4. 00 was not longer while the bile reflux represented by fraction time abs above 0. 14 was greater for patients in the group R as compared with those in the group P. The mixed refluxes and pure bile refluxes between the two groups had significant difference. The reflux episodes in the group R mainly occurred during nights. These results indicated that severe esophagitis, especially Barrett's esophagus with complications makes it difficult to control GERD. Severe duodenogastroesophageal refluxes (DGER) are often accompanied by refractory GERD. Mixed refluxes aggravate the esophageal injuries. Pure bile refluxes and nocturnal refluxes may cause failure of administration of proton pump inhibitors (PPI) in the morning. Helicobacter pylori infection and acid refluxes may not be the direct cause of refractoriness. Individual refractory GERD patient without abnormal results on pH or bile reflux recently should be diagnosed again.