Reviews for Primary Care - Fall 2007 - (Page 54) STATE-OF-THE-ART REVIEW Gastroesophageal Reflux Disease Symptoms on Antisecretory Therapy: Acid, Non-Acid, or No GERD Philip O. Katz, MD, FACP, FACG Division of Gastroenterology, Albert Einstein Medical Center, Philadelphia, PA A clinically important subset of patients with erosive esophagitis will not attain adequate symptom relief and healing on once-a-day proton pump inhibitor therapy. This is especially true in patients with frequent and nocturnal heartburn and in those with Los Angeles Grades C and D erosive esophagitis. The approach to evaluation and management of cases of refractory or difficult gastroesophageal reflux disease is the subject of this stateof-the-art review. © 2007 MedReviews, LLC he widespread use and availability of proton pump inhibitors (PPIs) has revolutionized the treatment of gastroesophageal reflux disease (GERD). The ability of these agents, given once daily, to heal erosive esophagitis and eliminate or improve symptoms is excellent. Unfortunately, despite the excellent efficacy of these agents, a clinically important subset of patients will fail to have adequate symptom relief and/or healing on once-a-day therapy. This is especially true in those with frequent and nocturnal heartburn and in patients with Los Angeles T 54 VOL. 1 NO. 1 2007 REVIEWS FOR PRIMARY CARE
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