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Abstract

About 30-40 % of GERD patients fail to respond to conventional treatments (standard or double dose of proton-pump inhibitors (PPI), prokinetics, low dose antidepressants) and, despite the efforts of the pharmaceutical companies to rule out new drugs beneficially affecting reflux pathophysiology, their management give rise to a major medical problem. However, there are preclinical and preliminary clinical evidences on the usage of newer, both pharmacological and non-pharmacological, remedies in refractory GERD management. These remedies need an accurate updated reviewing work in order to give to the physician a clear snapshot of 芒�?�?where are we now芒�?聺 in GERD management (describing refractory GERD definition and differential diagnosis, and the issues arising from conventional therapies) and 芒�?�?what we will do芒�?聺 about the most promising treatments for refractory GERD. This last issue is crucial because will condition the attention of physician towards some of newer remedies for this subset of patients, in synergy with the pharmaceutical industry. T.A.R.G.I.D. is the largest gastrointestinal translational laboratory across Europe that is a world referral center for the study of gastrointestinal motility, in general and of the GERD pathophysiology and treatment, in particular. According to my previous PhD program experience in and the actual collaboration with TARGID I will talk about: GERD definition and its physiopathology, refractory GERD definition and its pathophysiology issues, diagnostic flow-chart (including definition of overlap diseases and refractory GERD misdiagnosis (e.g. functional dyspepsia)), evidence-based therapeutic flow-chart including both pharmacological (older and newer PPI types and dosage, prokinetics, drugs affecting lower esophageal sphincter functioning) and non-pharmacological treatments (laparoscopic, endoscopic antireflux surgery), newer development directions in refractory GERD management.

Biography

Email: emidio.scarpellini@uniroma1.it