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World J Gastroenterol. Oct 21, 2013; 19(39): 6529-6535
Published online Oct 21, 2013. doi: 10.3748/wjg.v19.i39.6529
Published online Oct 21, 2013. doi: 10.3748/wjg.v19.i39.6529
Proton pump inhibitor resistance, the real challenge in gastro-esophageal reflux disease
Michele Cicala, Sara Emerenziani, Michele Pier Luca Guarino, Mentore Ribolsi, Unit of Digestive Disease, Campus Bio Medico University of Rome, 00128 Rome, Italy
Author contributions: Cicala M, Emerenziani S, Guarino MPL and Ribolsi M contributed equally to the manuscript, drafting the article and revising it critically for important intellectual content; All approve the final version for publication.
Correspondence to: Michele Cicala, MD, PhD, Unit of Digestive Disease, Campus Bio Medico University of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy. m.cicala@unicampus.it
Telephone: +39-6-22541560 Fax: +39-6-22541520
Received: June 25, 2013
Revised: July 31, 2013
Accepted: August 16, 2013
Published online: October 21, 2013
Revised: July 31, 2013
Accepted: August 16, 2013
Published online: October 21, 2013
Core Tip
Core tip: The present review focuses on the subgroup of patients in whom proton pump inhibitor refractoriness more frequently occurs, on the mechanisms possibly involved in the lack of response, the diagnostic work-up and the therapeutic strategies in these patients. Various mechanisms and factors have been demonstrated and some mechanisms have also been proposed, although not yet supported by strong evidence. In the management of these patients, a careful clinical interview might conduct the diagnostic evaluation and the therapeutic approaches.