Acid suppression in gastro-oesophageal reflux disease: Why? How? How much and when?

Jones, Mike

doi:10.1136/pmj.78.922.465

Cited by 8 publications

(7 citation statements)

References 20 publications

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“…Anemia, bleeding, and esophageal stenosis are serious complications of esophagitis caused by esophageal erosion or ulcer. Effective and strong acid suppression induces rapid healing of esophagitis and protects from complications because the severity of reflux esophagitis is correlated with the duration of esophageal acid exposure [50]. Therefore, PPI administration is required in GERD patients with complications.…”

Section: Medical Treatmentmentioning

confidence: 99%

Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015

et al. 2016

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As an increase in gastroesophageal reflux disease (GERD) has been reported in Japan, and public interest in GERD has been increasing, the Japanese Society of Gastroenterology published the Evidence-based Clinical Practice Guidelines for GERD (1st edition) in 2009. Six years have passed since its publication, and there have been a large number of reports in Japan concerning the epidemiology, pathophysiology, treatment, and Barrett's esophagus during this period. By incorporating the contents of these reports, the guidelines were completely revised, and a new edition was published in October 2015. The revised edition consists of eight items: epidemiology, pathophysiology, diagnosis, internal treatment, surgical treatment, esophagitis after surgery of the upper gastrointestinal tract, extraesophageal symptoms, and Barrett's esophagus. This paper summarizes these guidelines, particularly the parts related to the treatment for GERD. In the present revision, aggressive proton pump inhibitor (PPI) maintenance therapy is recommended for severe erosive GERD, and on-demand therapy or continuous maintenance therapy is recommended for mild erosive GERD or PPI-responsive non-erosive GERD. Moreover, PPI-resistant GERD (insufficient symptomatic improvement and/or esophageal mucosal break persisting despite the administration of PPI at a standard dose for 8 weeks) is defined, and a standard-dose PPI twice a day, change in PPI, change in the PPI timing of dosing, addition of a prokinetic drug, addition of rikkunshito (traditional Japanese herbal medicine), and addition of histamine H2-receptor antagonist are recommended for its treatment. If no improvement is observed even after these treatments, pathophysiological evaluation with esophageal impedancepH monitoring or esophageal manometry at an expert facility for diseases of the esophagus is recommended.

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Section: Medical Treatmentmentioning

confidence: 99%

Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015

et al. 2016

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“…The direct costs mainly refer to medical visits, diagnostic testing (gastroesophageal endoscopy, pH-metry and pH-impedance metry) and expenses for medications. The indirect costs of GERD, which are poorly characterized from a pharmacoeconomical point of view and which may be even higher than the direct costs [11, 12], are related to the social, familiar and economical impact of the disease, and include absenteeism and loss of workplace productivity, which are highly compromised in untreated GERD patients [13]. …”

Section: Treating Gerd: Medical and Economical Considerations On A ‘Mmentioning

confidence: 99%

Potential Options to Optimize Therapy of Gastroesophageal Reflux Disease with Proton Pump Inhibitors

et al. 2007

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Proton pump inhibitors (PPIs) are antisecretory agents that are widely used in the short- and long-term management of gastroesophageal reflux disease (GERD) to relieve symptoms, heal esophagitis, and prevent complications, such as strictures and Barrett’s esophagus. The total healthcare costs of GERD are high, especially for maintenance treatment. Therefore, the choice of cost-effective therapeutic options is an ineluctable challenge for public health authorities, third-party payers, and patients. In some European Union countries, a recent trend of public health authorities is to promote the choice of less expensive PPIs, regardless of their antisecretory potency – this in spite of the evidence that newer PPIs provide superior symptom relief and esophageal erosion healing compared to earlier drugs. Several large clinical trials have demonstrated the superiority of esomeprazole over other PPIs at standard doses for both initial and continuous maintenance therapy in patients with moderate/severe erosive esophagitis. The non-erosive GERD poses a major challenge as this condition appears more frequently to be less responsive to PPIs. The use of PPIs with the strongest antisecretory properties might reveal to be more adequate and cost-effective, particularly for this indication.

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“…The primary goals in the treatment of acid‐related diseases include adequate relief of symptoms, healing and prevention of complications 25, 26 . Individuals with an acid‐related disorder are most likely to see a physician because of persistent symptoms that have impaired their HRQOL.…”

Section: Discussionmentioning

confidence: 99%

“…It is also likely that they will first attempt to self‐medicate with the numerous available over‐the‐counter products, which include a PPI. A therapeutic agent with fast onset of symptom relief should not only contribute to patient satisfaction with treatment but also restore HRQOL 26 …”

Section: Discussionmentioning

confidence: 99%

“…There has been an increasingly recognized proclivity for many reflux patients to take their medications on demand – that is, self‐administering only when they are symptomatic and stopping once heartburn is relieved. Based on a 2000 Gallup survey, 45% of patients receiving prescriptions for omeprazole or lansoprazole once daily actually took the PPI on an often substantially less frequent basis 26 . In a study conducted in the United Kingdom, only 21% of a sampling of 209 patients on long‐term PPI therapy actually acquired sufficient prescription medication to be compliant with a once‐daily regimen.…”

Section: Discussionmentioning

confidence: 99%

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Review article: comparative pharmacodynamic review of rabeprazole – focus on day 1 data

Robinson

Barone

2006

Ali Pharm Thera Symp Ser

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Proton pump inhibitors have become the preferred therapy for gastrooesophageal reflux disease and other acid-related disorders. Without clear-cut clinical data to help clinicians differentiate the impact of the five currently available proton pump inhibitors on early symptom relief and health-related quality of life, we can explore potentially relevant differences in pharmacodynamic profiles of these proton pump inhibitors.In general, rabeprazole 10 and 20 mg achieve greater gastric pH >4 and >3 holding times and area under gastric pH-time curves on day 1 of treatment compared with other proton pump inhibitors. Superiority in day 1 pharmacodynamic measures corroborates fast antisecretory onset, and supports the premise that rabeprazole will be especially suitable for on-demand use. In particular, comparisons with omeprazole and esomeprazole suggest better day 1 nocturnal acid control with rabeprazole.Aliment Pharmacol Ther symp ser 2, 315-326

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Acid suppression in gastro-oesophageal reflux disease: Why? How? How much and when?

Cited by 8 publications

References 20 publications

Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015

Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015

Potential Options to Optimize Therapy of Gastroesophageal Reflux Disease with Proton Pump Inhibitors

Review article: comparative pharmacodynamic review of rabeprazole – focus on day 1 data

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