If you’re one of the many people who have been prescribed a proton pump inhibitor (PPI) medication to manage the discomfort of gastro-oesophageal reflux disease (GERD), you’re certainly not alone.
Omeprazole, commonly known under brand names like Prilosec and Losec, is one example of a PPI, along with others like Nexium (esomeprazole), Prevacid (lansoprazole), Protonix (pantoprazole) and Aciphex (rabeprazole).
It is estimated that nearly one-quarter of adults use a PPI. Of those using PPIs, 63 per cent are less than 65 years, while more than half (56 per cent) of PPI users are female.
How do they work?
The term ‘proton pump’ refers to an enzyme in the stomach lining that’s responsible for producing acid. This enzyme, known as the ‘hydrogen-potassium pump’, moves positively charged hydrogen ions (protons) into the stomach, creating hydrochloric acid.
PPIs work by blocking this enzyme, which means fewer protons are pumped into the stomach. The theory is that less acid production will lead to fewer symptoms of reflux giving the oesophagus the chance to recover from any damage.
For many, these medications offer welcome relief.
But do PPIs always work?
For some, PPIs fall short, leaving them with symptoms, such as heartburn, regurgitation or even nighttime reflux, that just won’t go away.
According to recent research, as many as 30 to 40 per cent of GERD patients experience what’s known as PPI-refractory GERD, meaning their symptoms persist despite taking PPIs as prescribed. For these patients, a different approach to treatment may be the key to finding lasting relief.
The study, Improving treatment of people with gastro-esophageal reflux disease refractory to proton pump inhibitors by Joachim Labenz and Sebastian F. Schoppmann, has been published in Communications Medicine, a peer-reviewed journal from Nature Portfolio.
What does it reveal?
Researchers say that while PPIs are very effective at reducing stomach acid, they’re not a one-size-fits-all solution.
Many patients continue to experience symptoms which can lead to disrupted sleep and an overall decrease in quality of life.
This latest study suggests that one reason for ongoing symptoms might be the complex causes behind reflux disease. Sometimes, it’s not just about acid; there are multiple factors at play, including anatomical ones like a weakened anti-reflux barrier in the oesophagus.
The anti-reflux barrier, primarily composed of the lower oesophageal sphincter and the crural diaphragm, helps prevent stomach contents from flowing back into the oesophagus.
What’s the plan next?
While some patients with ongoing symptoms might benefit from surgery, only a small fraction choose to go down that route. Concerns over surgery’s effectiveness and potential side effects often make patients and doctors wary. But the study suggests that surgical solutions can be effective when GERD is confirmed through careful testing, even if patients haven’t responded to PPIs.
What are the surgical options on the table?
The study outlines both traditional and newer surgical techniques for GERD, each with unique approaches to tackling reflux:
- Laparoscopic Fundoplication: This is the most established surgical method, where part of the stomach is wrapped around the oesophagus to reinforce the lower oesophageal sphincter and prevent acid from flowing back. It’s effective for many but can have side effects like bloating or difficulty swallowing.
- Magnetic Sphincter Augmentation (MSA): A newer option that uses a flexible ring of magnets around the oesophagus to support the anti-reflux barrier. This option aims to have fewer side effects compared to fundoplication.
- RefluxStop: This device is implanted on the stomach’s outer surface and aims to keep the oesophagus in place without constricting it, potentially reducing risks like difficulty swallowing.
The key takeaway from this study is that surgical treatment isn’t just about ‘last resort’ measures but rather about finding the right fit for each patient’s specific reflux challenges.
A call for more awareness and individualised care
The researchers point out that reflux patients often don’t receive the active follow-up needed to reassess their treatment options. Many patients with PPI-refractory GERD stay on medications that aren’t working for them or experience frustration for a long time without realising surgical or alternative treatments could be considered.
This study calls for regular check-ins and, when appropriate, referrals to specialists who can offer alternative treatments.
How Peptest can help
Peptest offers a way to assess whether your current treatment is effectively managing reflux. It measures pepsin in your saliva – a key digestive enzyme that should stay in the stomach, so its presence in the oesophagus or throat can indicate that stomach contents are refluxing back up – even if you’re taking medications.
Using Peptest can be especially helpful for people with PPI-refractory GERD, as it provides direct evidence of ongoing reflux episodes that might be missed in routine symptom-based assessments.
By testing your pepsin levels over time, you can gain valuable insights into how your body responds to different treatments, whether medical, lifestyle-based, or even surgical options.
Order your Peptest kit today to start tracking and managing your reflux symptoms.
Peptest detects pepsin — the stomach enzyme that marks reflux — in a saliva sample. Collected at home, analysed in our UK laboratory, results back within 48 hours.
- Results in 48 hours
- No GP referral needed
- UK laboratory
Recent Comments