Recent Advances in the Pharmacological Management of Gastroesophageal Reflux Disease

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...

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Bibliographic Details
Published in:Digestive diseases and sciences 2017-12, Vol.62 (12), p.3298-3316
Main Authors: Kung, Yu-Min, Hsu, Wen-Hung, Wu, Meng-Chieh, Wang, Jiunn-Wei, Liu, Chung-Jung, Su, Yu-Chung, Kuo, Chao-Hung, Kuo, Fu-Chen, Wu, Deng-Chyang, Wang, Yao-Kuang
Format: Article
Language:English
Subjects:
Alginates - therapeutic use
Behavior therapy
Behavioral health care
Biochemistry
Cognition & reasoning
Cognitive behavioral therapy
Cognitive therapy
Drug development
Esophageal Sphincter, Lower - drug effects
Esophagus
Gastroenterology
Gastroesophageal reflux
Gastroesophageal Reflux - drug therapy
Gastrointestinal Agents - pharmacology
Gastrointestinal Agents - therapeutic use
Glucuronic Acid - therapeutic use
Hepatology
Hexuronic Acids - therapeutic use
Histamine
Histamine H2 Antagonists - therapeutic use
Humans
Medical colleges
Medicine
Medicine & Public Health
Oncology
Proton Pump Inhibitors - therapeutic use
Protons
Review
Transplant Surgery
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Summary: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.
ISSN:0163-2116
1573-2568
DOI:10.1007/s10620-017-4830-5