gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLCgastro-j-1431Research ArticleЛЕКЦИИ И ОБЗОРЫLECTURES AND REVIEWSГастроэзофагеальная рефлюксная болезнь, резистентная к терапии ингибиторами протонной помпыGastroesophageal reflux disease, resistant to proton pump inhibitorsКайбышеваВ. О.KaybyshevaV. O.ТрухмановА. С.TrukhmanovA. S.ИвашкинВ. Т.IvashkinV. T.ГОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова Росздрава»Russian Federation201106062011214413Copyright © Кайбышева В.О., Трухманов А.С., Ивашкин В.Т., 20112011Кайбышева В.О., Трухманов А.С., Ивашкин В.Т.Kaybysheva V.O., Trukhmanov A.S., Ivashkin V.T.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/1431

Цель обзора. Обсудить факторы, способствующие формированию резистентности при лечении гастроэзофагеальной рефлюксной болезни (ГЭРБ), и возможные способы ее преодоления.Основные положения. Лекарственная терапия ГЭРБ сфокусирована на изменении свойств рефлюктата в сторону снижения его объема и агрессивности с помощью таких классов препаратов, как антациды, алгинаты и ингибиторы секреции соляной кислоты. Однако на сегодняшний день частота клинической неэффективности лечения при ГЭРБ составляет 10–40%. Причинами резистентности к антисекреторной терапии являются недостаточная кислотосупрессия, слабокислый характер рефлюкса, дуоденогастроэзофагеальный рефлюкс, психологические особенности больных и др. Возможности лечения пациентов, сохраняющих симптомы ГЭРБ на фоне приема стандартной дозы ингибиторов протонной помпы (ИПП), заключаются в правильном приеме препаратов, удвоении дозы ИПП, применении внутривенных лекарственных форм, комбинации антисекреторных средств из разных групп, добавлении к терапии препаратов, адсорбирующих компоненты желчи, влиянии на психоэмоциональный статус пациентов.Заключение. Несмотря на значительный прогресс в лечении кислотозависимых заболеваний проблема резистентности значительной части больных ГЭРБ к антисекреторной терапии сохраняется.

The aim of review

The aim of review. To discuss the factors, promoting development of resistance at treatment of gastroesophageal reflux disease (GERD), and possible means to overcome it.

Original positions

Original positions. Pharmacological therapy of GERD is focused on change of refluxate properties besides decreasing of its volume and aggressive properties by such classes of drugs, as antacids, alginates and hydrochloric acid secretion inhibitors. However for today frequency of clinical resistance in GERD patients reaches 10–40%. The causes of resistance to antisecretory therapy are inadequate acid suppression, weakly acidic refluxes, duodenogastroesophageal reflux, psychological features of patients, etc. Potentials of treatment of the patients with sustained symptoms of GERD on a background of standard dose of proton pump inhibitors (PPI), include correction drug intake, doubling of PPI dose, application of intravenous forms, combination of antisecretory agents of different groups, addition to therapy of drugs, capable to adsorb bile components and modulation of psychoemotional status of patients.

Conclusion

Conclusion. Despite of significant progress in treatment of acid-related diseases the problem of resistance of significant part of GERD patients to antisecretory therapy is still actual.

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