Pharmacological Management of Gastro-Esophageal Reflux Disease: An Update of the State-of-the-Art

Abstract

Gastro-esophageal reflux disease (GERD) is a highly prevalent, chronic disorder, whose knowledge remains limited and the management of these patients changes continuously. This review provides a summary of the most recent advancements in the pathogenesis of this disease and the new drugs introduced into the market to overcome some of the unmet needs of traditional therapies. Nowadays, the most fruitful diagnostic examinations are 24hour impedance-pH monitoring, which allows us to separate true NERD from esophageal functional disorders and high-resolution manometry, which helps to exclude the existence of motility disorders sharing the same symptoms of GERD. Proton pump inhibitors (PPIs) remain the first-choice therapy in the treatment of GERD, but a consistent proportion of these patients continue to experience symptoms despite their intake. These cases pertain mainly to the subpopulation with non-erosive reflux disease (NERD) and represent very challenging clinical situations, because it is mandatory to understand the reasons for PPI failure. The management of these difficult patients requires necessarily to test them and avoid the use of empiric treatments that are often unsuccessful, costly and potentially dangerous. Recently, several new drugs have been used to increase the defensive properties of this mucosa with promising results in randomized clinical trials.

Association of CYP2C19 Polymorphism With Proton Pump Inhibitors Effectiveness and With Fractures in Real‐Life: Retrospective Cohort Study

“…Patients who failed to obtain satisfactory symptomatic response or complete esophageal healing after a full course of standard dose PPI are defined as having PPI failure; a definition that allows inclusion of patients who perceived their remaining symptoms on PPI therapy as bothersome. 4 , 5 , 6 A study in 11,064 patients with chronic heartburn found that, although PPIs were the preferred class of medications for preventing heartburn, only 58% of PPI recipients reported being totally satisfied with their anti‐reflux treatment. 7 A systematic review that included 9 studies of 14,774 patients showed improved health‐related quality of life in patients who responded well to PPI treatment, but not in nonresponders.…”

Refractory Gastroesophageal Reflux Disease: A Management Update

“…Due to the ability of binding bile salts, it could be of help also in WAR and/or WalkR. A new class of disposable medical agents, made up of a bioadhesive formulation of hyaluronic acid and chondroitin sulfate, was recently shown to improve symptoms and quality of life as an add-on therapy to PPI when compared to PPI alone in patients with NERD ( 125 , 126 ). Despite their use in patients with rGERD not having been evaluated yet, they could be of help in some patients because they target an additional pathophysiological mechanism.…”

Horned Melon (Cucumis metuliferus E. Meyer Ex. Naudin)—Current Knowledge on Its Phytochemicals, Biological Benefits, and Potential Applications

“…Potassium, phosphorus, magnesium, and other minerals present in horned melon pulp are significant for nerve transmission, muscle contraction, blood clotting, blood pressure regulation, immune system health, etc. [14].…”