Treatment of gastroesophageal reflux disease

Abstract

Objective: To review the literature on the treatment of gastroesophageal reflux disease (GERD) with emphasis on pharmacological aspects. To identify particularities of pharmacological treatment of esophageal and extraesophageal manifestations of the disease.Sources: Electronic search of the PubMed/MEDLINE and Cochrane Collaboration databases. Controlled and randomized studies published since 2000 and reviews representing consensus positions and directives published within the last 10 years were identified. Summary of the findings:The drugs currently available for the treatment of GERD do not act in the primary mechanism of the disease, i.e., transitory relaxation of the lower esophageal sphincter. Pharmacological treatment of GERD with symptoms or with esophageal injury is based on the suppression of acid secretion, particularly with proton pump inhibitors. When the hyperreactivity of the lower airways coexists with esophageal GERD symptoms, suppression of acid secretions should be of benefit in managing the respiratory disease in the presence of a causal relationship; however, this is not usual. When esophageal symptoms are not present, esophageal 24-hour pH study should be carried out prior to starting pharmacological treatment for GERD. Improvement of respiratory symptoms may be delayed with relation to esophageal symptoms. It is common for GERD to recur and pharmacological treatment should be repeated or continued indefinitely, depending on clinical presentation of the disease. Conclusions:The strategies that have been proposed for the pharmacological treatment of GERD in children are primarily based on studies of case series or on studies with adults. There have been very few controlled and randomized studies in children. Undertaking a greater number of these studies might reinforce existing aspects or establish new aspects of management.J Pediatr (Rio J). 2006;82(5 Suppl):S133-45: Gastroesophageal reflux, child, drug therapy, esophagitis, respiratory tract diseases, asthma. ResumoObjetivo: Rever a literatura sobre tratamento da doença do refluxo gastroesofágico (DRGE) com ênfase nos aspectos farmacológi-cos. Identificar particularidades do tratamento farmacológico nas manifestações esofágicas e extra-esofágicas da doença.Fontes de dados: Busca eletrônica na base de dados PubMed/ MEDLINE e Cochrane Collaboration. Procurou-se identificar estudos controlados e randomizados publicados a partir de 2000, bem como revisões que representassem consensos e diretrizes publicados nos últimos 10 anos.Síntese dos dados: Nenhuma das drogas atualmente usadas no tratamento da DRGE altera comprovadamente o mecanismo principal da doença, ou seja, os relaxamentos transitórios do esfíncter esofágico inferior. O tratamento farmacológico da DRGE com sintomas ou com lesões esofágicas é baseado na inibição da secreção ácida, em particular pelos inibidores da bomba de prótons (IBP). Nas situações em que a hiper-reatividade das vias aéreas inferiores coexiste com sintomas esofágicos da DRGE, a inibição da secreção ácida deve...

Construct validity of a figure rating scale for Brazilian adolescents

“…The new references for evaluation of the nutritional status of Brazilian children based on the distribution of BMI values [25] were used. To calculate the z-score, LMS values were used, by age and gender, according to the following formula:…”

“…Nutritional status was determined according to the criteria of Conde and Monteiro [25] for BMI values by gender and age. The children were thus diagnosed as normal or overweight including obesity.…”

Median ages at stages of sexual maturity and excess weight in school children

“…The new references for evaluation of the nutritional status of Brazilian children based on the distribution of BMI values [17] were used. To calculate the z-score, LMS values were used, by age and gender, according to the following formula:…”

Çocuklarda Gastroözofagiyal Reflü Hastalığı

“…Kilo verme, sigarayı bırakma sol yana yatma, yatmadan önce en az 1 saat önce yemek yemiş olmak, düşük karbonhidratlı yemek yemek ve yatak başını kaldırarak uyuma önerilmektedir. Yemeklerden sonra sakız çiğnemenin reflüyü azalttığı bildirilmiştir (1,3,5,6,26). Çalışmalarda GÖRH'a bağlı olduğu düşünülen ancak kanıtlanmamış olgularda PPI'ların yararlı olmadığı gösterilmiştir.…”