Role of gastric acid suppression in the treatment of gastro-oesophageal reflux disease.

Abstract

Gastro-oesophageal reflux disease is a common condition with a complex pathophysiology. Despite the spectrum of abnormalities, gastric acid has a central role in mucosal damage, and the mainstay of medical treatment is suppression of gastric acid secretion. The results of antisecretory treatment as assessed by endoscopic healing are reviewed. H2 receptor antagonists give more rapid symptom relief than placebo and can produce endoscopic improvement in 31-88% of cases depending on the severity of oesophagitis. Complete healing, however, is seen only in 27-45% of patients and these have mainly grades I-II disease. Improved healing rates can be obtained by increasing the degree of acid suppression or the length of treatment. The addition of a prokinetic agent may be beneficial. Omeprazole heals 67-92% of patients overall and although most successful in the lower grades of oesophagitis, can also heal 48-62% of patients with grade IV disease. The degree and rate ofhealing seem to be related to the reduction in oesophageal acid exposure and thus may correlate with the degree and duration of acid suppression over 24 hours obtained by the various treatments. The underlying pathophysiology is unchanged, however, and long term treatment may be needed to maintain remission.

Comparative study of omeprazole, lansoprazole, pantoprazole and esomeprazole for symptom relief in patients with reflux esophagitis

“…Healing of reflux esophagitis is directly correlated with the intragastric pH > 4.0 [8,9] . The efficacy of antisecretory drugs in healing reflux esophagitis depends on the strength and duration of acid suppression within a 24 h period, and the duration of the treatment [10] . Proton pump inhibitor (PPI) therapy is effective for acid-related symptoms.…”

Antileishmanial Activity of the Antiulcer Agent Omeprazole

“…The protonated form becomes an active sulfenamide compound and acts as a potent ATPase inhibitor (13). In the human stomach, activated omeprazole was shown to inhibit the gastric K ϩ ,H ϩ -ATPase and halt acid secretion by parietal cells (5).…”

“…are dimorphic organisms which exist as flagellated promastigotes in the sandfly gut and as aflagellated amastigotes in mammalian macrophages (9). Since they exist within the phagolysosomes of mammalian macrophages, amastigotes are relatively protected from the host immune responses and chemotherapeutics (1,5,6). The phagolysosomal environment is acidic (pH 4.0 to 5.0) in rat, human, and mouse macrophages (8,15,18).…”

Comparative study of Omeprazole, Rabeprazole and Ilaprazole for their efficacy in patient suffering from reflux esophagitis with symptoms.

“…[21].Healing of reflux esophagitis is directly correlatedwith the intragastric pH > 4.0. The efficacy ofantisecretory drugs in healing reflux esophagitis dependson the strength and duration of acid suppression withina 24 h period, and the duration of the treatment [22][23][24].The time period required to obtain maximal inhibitionof gastric acid secretion is, however, reported to differbetween PPI [25][26][27] . As thequality of life (QOL) of patients with reflux esophagitisis decreased by heartburn symptoms, quick symptomrelief is important to normalize their QOL.…”