Tactics of management of refractory form of gastroesophageal reflux disease that developed in a patient after cholecystectomy: a clinical case

The prevalence of gastroesophageal reflux disease (GERD) in the human population exceeds 20%. Proton pump inhibitors (PPIs) are the main group of drugs for the treatment of this disease. Nevertheless, according data provided, PPI-refractory form of GERD occurs in 28–54.1% of persons suffering from this disease. The results of studies indicate that PPIs are good at stopping typical reflux syndrome, but are often not effective in atypical and extraesophageal manifestations of the disease. The pathogenesis of PPI-refractory GERD is associated predominantly with non-acid refluxes and visceral hypersensitivity. Thus, the administration of alginic acid preparations can be an effective treatment for PPI-refractory GERD. This is due to the fact that alginates are able to bind pepsin and bile acids, limiting their diffusion and reducing the enzymatic activity of pepsin. We demonstrate a clinical case of a patient suffering from PPI-refractory form of GERD, the complete relief of symptoms of which became possible only after the addition of alginate to therapy with rabeprazole in a standard dose.