gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLCgastro-j-1133Research ArticleЛЕКЦИИ И ОБЗОРЫLECTURES AND REVIEWSНовый взгляд на проблему гастроэзофагеальной рефлюксной болезни, рефрактерной к лечению ингибиторами протонной помпыNew opinion on the issue of proton pump inhibitor-refractory gastroesophageal reflux diseaseЕвсютинаЮ. В.YevsyutinaYu. V.

Евсютина Юлия Викторовна – аспирант кафедры пропедевтики внутренних болезней

119991, Москва, ул. Погодинская, д. 1, стр. 1

Yevsyutina Yuliya V — post-graduate student, Chair of internal diseases propedeutics, medical faculty 

119991, Moscow, Pogodinskaya street, 1, bld 1

uselina@mail.ruТрухмановА. С.TrukhmanovA. S.

Трухманов Александр Сергеевич – доктор медицинских наук, профессор кафедры пропедевтики внутренних болезней

119991, Москва, ул. Погодинская, д. 1, стр. 1

Trukhmanov Aleksander S — MD, PhD, professor, Chair of internal diseases propedeutics, medical faculty

119991, Moscow, Pogodinskaya street, 1, bld 1

ГБОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава РоссииРоссияState educational government-financed institution of higher professional education «Sechenov First Moscow state medical university»Russian Federation201422042024245410Copyright © Евсютина Ю.В., Трухманов А.С., 20142014Евсютина Ю.В., Трухманов А.С.Yevsyutina Y.V., Trukhmanov A.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/1133

Цель обзора. Представить современные данные о причинах развития гастроэзофагеальной рефлюксной болезни (ГЭРБ), рефрактерной к лечению ингибиторами протонной помпы (ИПП).Основные положения. Распространенность ГЭРБ достигает 20–30% в популяции, при этом примерно 40–50% пациентов не отвечают на стандартную терапию ИПП. При ГЭРБ происходит нарушение иммунного ответа в виде дисбаланса между клеточным и гуморальным звеньями иммунитета, что может быть детерминировано как фенотипом макрофагов (М1 или М2), так и другими иммунными и неиммунными клетками.Заключение. На настоящий момент становится ясно, что только низкой приверженностью пациентов к лечению ИПП, наличием полиморфизма изофермента CYP2C19 цитохрома Р450 и другими известными причинами нельзя объяснить растущее число больных с рефрактерной ГЭРБ. Поэтому изучение заболевания на клеточном и тканевом уровнях в зависимости от типа повреждающего рефлюктата может помочь открыть новые механизмы формирования рефрактерной ГЭРБ и повысить в дальнейшем эффективность ее лечения.

The aim of review

The aim of review. To present up-to-date data on the causes of proton pump inhibitor-refractory gastroesophageal reflux disease (GERD) development.

Summary

Summary. The prevalence of GERD reaches 20–30% of population, and approximately 40–50% of patients do not respond to standard treatment by proton pump inhibitors (PPI). There is a disorder of the immune response as a disbalance between cellular and humoral components of immunity at GERD, that can be determined as phenotype of macrophages (М1 or М2), and other immune and non-immune cells.

Conclusion

Conclusion. For the present moment it becomes clear, that low compliance of patients to PPI treatment, cytochrome Р450 isoenzyme CYP2C19 polymorphism and other known reasons are unable to explain growing number of refractory GERD cases. Therefore, studying of disease at cellular and tissue levels in relation to type of refluxate can disclose new mechanisms of refractory GERD and to increase treatment efficacy.

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The authors declare that there are no conflicts of interest present.