Historical Perspective of Gastroesophageal Reflux Disease Clinical Treatment

Abstract

BACKGROUND: Gastroesophageal reflux disease (GERD) is one of the most prevalent gastrointestinal diseases. GERD generates significant impairment in patients’ quality of life and it is associated to relevant medical resources utilization. A better understanding of GERD pathophysiology in the past five decades has favored the evolution of therapeutic strategies from non-drug interventions and antacids to more efficacious and safer alternatives. OBJECTIVE: To summarize data about the historical evolution of GERD management in Brazil, focusing on medical therapy and addressing evidence on efficacy and safety of drug classes currently recommended. METHODS: A narrative review was conducted by systematizing information about discoveries on GERD pathophysiology. We also addressed efficacy and safety of medications currently used to reduce symptoms and improve endoscopic healing of esophageal lesions. A structured search on Pubmed was performed to identify systematic reviews and meta-analysis investigating GERD outcomes positively impacted by proton pump inhibitors (PPIs), the first choice of pharmacotherapy for the disease. RESULTS: The chronological development of therapeutic measures for GERD in Brazil evolved from lifestyle interventions with relative poor effect on symptoms related to esophageal acid exposure, particularly heartburn, to effective and safe pharmacological interventions such as histamine H2-receptor antagonists and PPIs. In the present days, some drug classes play a minor role in disease management, namely prokinetics and antacids, due to their reduced efficacy and relevant safety concerns (particularly with prokinetics). The main challenge for prescribers and researchers seems to be finding long-acting acid suppressants strategies able to ameliorate patients’ symptoms and quality of life, thereafter, reducing medical resource consumption. The dual delayed-release PPI dexlansoprazole seems to respond for some of the limitations other PPIs have. CONCLUSION: Recognizing the historical evolution of GERD management can help care providers to better understand therapeutic options for their patients, as well as focus on unmet needs that deserve further attention. PPIs are still the first choice therapy, with good evidence in favor of their efficacy, despite some safety concerns. However, as with any medical intervention, it is recommended to prescribe PPIs for patients with clear indication, using adequate dosing and monitoring for adverse events.

Prevalence of Gastroesophageal Reflux Disease and Associated Risk Factors in the Eastern Region, Saudi Arabia

“…Recent epidemiological studies showed there was increasing GERD prevalence worldwide [3]. The worldwide [1,5].…”

“…The heartburn can radiate to the neck and it is aggressive after meals or during lying down position [ 2 ]. GERD has also extra-esophageal symptoms like chronic cough, asthma, and sometimes tissue lesions [ 3 ]. GERD has unknown causes, it is mostly caused by multifactorial pathogenesis like esophagogastric junction dysfunction, hypersensitivity of the esophagus, impaired esophageal bolus transit, and high intragastric pressure [ 4 ].…”

“…Recent epidemiological studies showed there was increasing GERD prevalence worldwide [ 3 ]. The worldwide estimated prevalence of GERD ranged from 15 to 25%, Saudi Arabia reported 15-45.4%, western Asia reported 10-20%, the Middle East reported 8.7-33.1%, and eastern Asia reported less than 10% [ 1 , 5 ].…”

Doença do refluxo gastroesofágico - uma revisão da literatura/ Gastroesophageal reflux disease - a review of the literature

“…Entretanto, o aumento Brazilian Journal of Health Review, Curitiba, v.4, n.3, p. 14245-14253 may./jun. 2021 da prevalência também pode ser explicado devido aos avanços dos métodos diagnósticos e do melhor entendimento das características da doença (ZATERKA et al, 2019).…”

Potassium-competitive acid blockers, a new therapeutic class, and their role in acid-related diseases: a narrative review

“…Evolution of GERD treatment in Brazil. Modified from Zaterka et al (2019)[11] H2RAs -histamine H2-receptor antagonists, P-CABs -potassium-competitive acid blockers, PPI -proton pump inhibitors.…”