الفهرس 
Introduction and Aim of the WorkOnly 14 pages are availabe for public view
 |  | from | 232 |  |  |
| | | from | 232 | | |
Abstract
The aim of the work is:
1- To study the esophageal motility in patients with GERD on PPI BID and to compare patients with continued abnormal nocturnal GERD on PPI BID to patients who have no nocturnal GERD on PPI BID regarding their esophageal motility.
2- To compare different treatment modalities in patients with nocturnal GERD on PPI BID.
Conclusions:
1- Patients with chronic GERD should have ambulatory gastric and esophageal PH monitoring in addition to esophageal manometry.
2- Infective esophageal motility and hypotensive LES are common findings in patients with refractory GERD on PPI BID.
3- Multiple regimens are effective in control of refractory GERD. Treatment of refractory GERD on PPI BID may be individualized:
a) Patients with IEM or hypotensive LES: Cisapride may be the first choice to be added to their treatment.
b) Patients with normal esophageal motility and or long gastric acid breakthrough time: ranitidine may be the fist choice to be added to their treatment.
c) Laparoscopic fundoplication may be indicated in young patients with chronic GERD in presence of expert surgeon. It is also indicated in the lack of patient compliance, intolerance to medications, or severe complications.