Published in:
01-12-2017 | Review
Recent Advances in the Pharmacological Management of Gastroesophageal Reflux Disease
Authors:
Yu-Min Kung, Wen-Hung Hsu, Meng-Chieh Wu, Jiunn-Wei Wang, Chung-Jung Liu, Yu-Chung Su, Chao-Hung Kuo, Fu-Chen Kuo, Deng-Chyang Wu, Yao-Kuang Wang
Published in:
Digestive Diseases and Sciences
|
Issue 12/2017
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Abstract
The management of proton pump inhibitor-refractory GERD (rGERD) is a challenge in clinical practice. Since up to one-third of patients with typical GERD symptoms (heartburn and/or acid regurgitation) are not satisfied with proton pump inhibitor (PPI) therapy, new drug development targeting different pathophysiologies of GERD is imperative. At present, no other drugs serve as a more potent acid suppression agent than PPIs. As an add-on therapy, histamine type-2 receptor antagonists, alginates, prokinetics and transient lower esophageal sphincter relaxation inhibitors have some impact on the subgroups of rGERD, but greater effectiveness and fewer adverse effects for widespread use are required. Visceral hypersensitivity also contributes to the perception of GERD symptoms, and neuromodulators including antidepressants play a role in this category. Esophageal pH-impedance monitoring helps to distinguish functional heartburn from true GERD, and psychologic medication and cognitive behavior therapy are further therapy options instead of PPIs.