Medical Therapy for Gastroesophageal Reflux Disease

Arora, Amindra S.; Castell, Donald O.

doi:10.4065/76.1.102

Cited by 7 publications

(4 citation statements)

References 39 publications

(33 reference statements)

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“…Gastroesophageal reflux disease (GERD) is a common condition caused by reflux of gastric contents into the esophagus producing symptoms such as heartburn or regurgitation. 1 In patients having GERD symptoms at least once weekly, 74% reported having nocturnal symptoms. 2 Nocturnal reflux episodes are associated with complications such as esophageal erosions, ulceration, Barrett's esophagus, esophageal adenocarcinoma, and respiratory problems.…”

Section: Introductionmentioning

confidence: 99%

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Twice-daily proton pump inhibitor therapy does not decrease the frequency of reflux episodes during nocturnal recumbency in patients with refractory GERD: analysis of 200 patients using multichannel intraluminal impedance-pH testing

Clayton

Rife

Singh

et al. 2012

Diseases of the Esophagus

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Over half of patients with gastroesophageal reflux disease (GERD) report nocturnal symptoms. Proton pump inhibitors (PPIs) are the main medications used to treat GERD. Multichannel intraluminal impedance with pH (MII-pH) monitoring is the most sensitive method for detection and characterization of GERD. The aim of this study was to assess and compare reflux frequency in patients with refractory GERD symptoms on and off PPI therapy during the nocturnal recumbent period, as assessed by MII-pH testing. We analyzed 24-hour MII-pH studies performed in 200 patients monitored either on twice-daily (n = 100) or off (n = 100) PPI therapy. Demographic analysis of the on-therapy group revealed a mean age of 52 years (24-78 years) with 37% males, and the off-therapy group revealed a mean age of 49 years (18-84 years) with 40% males. All studies were interpreted to assess and characterize the number of acid and nonacid reflux episodes in the nocturnal recumbent period identified by each patient on an overnight recorder (Zephyr, Sandhill Scientific, Inc., Highlands Ranch, CO, USA). The nocturnal recumbent period was the period documented by patients during which they lie in the recumbent period at night to sleep with average periods lasting 456 and 453 minutes for patients on and off PPI therapy. There were more mean recumbent reflux episodes in the on-therapy group in comparison with the off-therapy group (3.76 mean reflux episodes [mre] per patient in the recumbent vs. 2.82 mre); the difference was not statistically significant (P = 0.187). When the reflux events are classified into acid and non-acid reflux episodes, the relative occurrence of acid reflux events is less in the on-therapy group (P = 0.047), while the off-therapy group have fewer nonacid reflux episodes (P = 0.003). PPIs decrease the acidity of esophageal refluxate but do not decrease the relative frequency of reflux episodes in the recumbent position in patients with refractory GERD despite twice-a-day treatment with PPI therapy. The explanation for the finding of numerically increased, although not statistically significant, amount of reflux episodes in the PPI treatment group in this study, and previous studies is unclear and warrants further evaluation.

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Section: Introductionmentioning

confidence: 99%

“…Gastroesophageal reflux disease (GERD) is a common condition caused by reflux of gastric contents into the esophagus producing symptoms such as heartburn or regurgitation 1 . In patients having GERD symptoms at least once weekly, 74% reported having nocturnal symptoms 2 .…”

Section: Introductionmentioning

confidence: 99%

Twice-daily proton pump inhibitor therapy does not decrease the frequency of reflux episodes during nocturnal recumbency in patients with refractory GERD: analysis of 200 patients using multichannel intraluminal impedance-pH testing

Clayton

Rife

Singh

et al. 2012

Diseases of the Esophagus

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“…Complications of GERD range from the development of acid‐related oesophageal strictures, ulcerative oesophagitis with gross haemorrhage or occult bleeding leading to anaemia, Barrett oesophagus and oesophageal adenocarcinoma 4 …”

Section: Introductionmentioning

confidence: 99%

Quality of life in acute and maintenance treatment of non‐erosive and mild erosive gastro‐oesophageal reflux disease

Pace

Negrini

Rossi

et al. 2005

Aliment Pharmacol Ther

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Summary Background: Quality of life has been assessed in a large, multicentre randomized, open label study. Aim: To evaluate the economic and clinical consequences of two different maintenance treatment modalities, administered to 6017 gastro‐oesophageal reflux disease patients at 451 gastroenterological centres in Italy. Methods: Adult gastro‐oesophageal reflux disease patients received, at enrolment, an acute treatment of esomeprazole 40 mg/day for 4 weeks and, if successfully treated, were randomized into two maintenance treatment strategies: esomeprazole 20 mg/day or esomeprazole on demand for 6 months. A baseline endoscopy allowed the exclusion of grade II–IV oesophagitis according to Savary–Miller's classification. Burden of gastro‐oesophageal reflux disease was measured at baseline by the generic questionnaire Short‐Form 36 and by a disease specific instrument, quality of life in reflux and dyspepsia (QOLRAD), also administered at start and conclusion of maintenance period. Investigators were required to collect patient judgement about the degree of satisfaction with treatment effect on heartburn, with a 7‐point scale. Results: A comparison between Short‐Form 36 scores and the normative source of the Italian general population suggested that symptomatic gastro‐oesophageal reflux disease patients experience a worse quality of life than the general population. At the end of the 4‐week treatment with esomeprazole 40 mg all (QOLRAD) dimensions showed a statistically significant (P < 0.0001) and clinically meaningful improvement. Satisfaction level towards treatment was reported high in the total enrolled population after acute treatment with esomeprazole 40 mg/day (96.2% satisfied and 64.4% very satisfied). A statistically significant difference in (QOLRAD) scores was registered at the end of maintenance phase in favour of the continuous regimen, nevertheless the size of this difference was very small in all dimensions; similarly, the proportion of patients very satisfied was slightly higher in the continuous treatment arm (64.5%) than in the on‐demand arm (59.7%). Conclusions: Gastro‐oesophageal reflux disease can significantly impair health‐related quality of life and esomeprazole therapy allows immediate relief in the acute phase of the disease. Quality of life improvement was maintained during the 6‐month follow‐up with a slight difference in term of quality of life in reflux and dyspepsia scores and patients’ satisfaction in favour of the continuous treatment strategy.

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“…However, gastroesophageal reflux disease is defined as exposure of the distal esophagus to acid for greater than 4% to 5% of the time in a 24-hour period. The development of GERD involves a number of factors: 1) excess transient LES relaxations (TLESR); 2) decreased esophageal clearance; 3) poor LES tone; and 4) gastric distention [33,34]. In healthy subjects, primary esophageal peristalsis is the initial response to acid reflux.…”

Section: Gastroesophageal Reflux Diseasementioning

confidence: 99%

Practical approaches to dysphagia caused by Esophageal motor disorders

Arora

Conklin

2001

Curr Gastroenterol Rep

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Dysphagia is a common symptom with which patients present. This review focuses primarily on the esophageal motor disorders that result in dysphagia. Following a brief description of the normal swallowing mechanisms and the messengers involved, more specific motor abnormalities are discussed. The importance of achalasia, as the only pathophysiologically defined esophageal motor disorder, is discussed in some detail, including recent developments in pathogenesis and treatment options. Other esophageal spastic disorders are described, with relevant manometric tracings included. In recent years, the importance of gastroesophageal reflux as a primary cause of esophageal dysmotility has been recognized, and this is also discussed. In addition, the motility disturbances that develop after surgical fundoplication are reviewed.

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Medical Therapy for Gastroesophageal Reflux Disease

Cited by 7 publications

References 39 publications

Twice-daily proton pump inhibitor therapy does not decrease the frequency of reflux episodes during nocturnal recumbency in patients with refractory GERD: analysis of 200 patients using multichannel intraluminal impedance-pH testing

Twice-daily proton pump inhibitor therapy does not decrease the frequency of reflux episodes during nocturnal recumbency in patients with refractory GERD: analysis of 200 patients using multichannel intraluminal impedance-pH testing

Quality of life in acute and maintenance treatment of non‐erosive and mild erosive gastro‐oesophageal reflux disease

Practical approaches to dysphagia caused by Esophageal motor disorders

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