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.
1. Sifrim D., Zerbib F. Diagnosis and
management of patients with reflux symptoms
refractory to proton pump inhibitors//
Gut.2012. Vol. 61. 9. .1340-54.
2. .., .., ..
XXI / .. , ..
, .. // .
. 2015. .
2. 15. . 42-47.
3. ..
( I). ,
/..
// -. 2014.
- 1- 2. .2-14.
4.
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(
XVII
, 1012
2017 ) / .. , .. , ..
//
, ,
. 2012. 5. .13-23.
5. .. : ,
, .
/ .. //
- .
. 2006. C. 96103.
6. Aziz Q., Fass R., Gyawali C.P., Miwa H.,
Pandolfino J.E., Zerbib F. Functional
Esophageal Disorders //Gastroenterology. 2016. Vol. 150. .1368-1379.
7. Malfertheiner P., Megraud F., O'Morain
C.A. et al. Management of Helicobacter pylori
infection - the Maastricht IV. Florence
Consensus Report // Gut. 2012. Vol. 61. .
646-664.
8. Sharma N., Agrawal A., Freeman J. et al.
An analysis of persistent symptoms in
acidsuppressed patients undergoing
impedance-pH monitoring // Clin Gastroenterol
Hepatol. 2008. Vol.6. .521-524.
9. Fass R., Sifrim D. Management of
heartburn not responding to proton pump
inhibitors //Gut. 2009. Vol. 58. .295-309.
10. Farre R., Van Malenstein M.H., de Vos
R. Weakly acidic solutions containing pepsin
and bile acids can increase significantly
esophageal mucosa permeability //Gastroenterology.
2007. Vol. 132. 4 (2). P.1897.
11. .., ..
,
. //
.-2015.- 8.- . 1821.
12.
.
// .. , .. , .. , .. , ..
, .. , .. ,
.. , .. , ..
, .. , .. , ..
//
. 2014. 23 .
13. .. / ..
. .: , 2010. 1072 .
14. .., ..,
.. ,
- (
) / ..
, .. , .. //
. - 2016.- 1 (1).
.19-24.
15. .., ..,
..
/ .. , ..
, .. //
. 2016. .1,2.
.167-171.
16. Penagini R., Sweis R., Mauro A.,
Domingues G., Vales A., Daniel Sifrim D.
Inconsistency in the diagnosis of functional
heartburn: usefulness of prolonged wireless pH
monitoring in patients with proton pump
inhibitor refractory gastroesophageal reflux
disease//J. Neurogastroenterol. Motil.2015.
Vol.21. No. 2. P. 265-272.
17. Drossman D.A. Functional
gastrointestinal disorders: history,
pathophysiology, clinical features and Rome IV
//Gastroenterology. 2016. Vol. 150. P.
12621279.
18. Yoshida N., Kuroda M., Suzuki T.,
Kamada K., Uchiyama K., Handa O. et al.Role of
nociceptors/neuropeptides in the pathogenesis
of visceral hypersensitivity of nonerosive
reflux disease//Dig. Dis. Sci.2013. Vol.58. P.
2237-2243.
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