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Dig Dis Sci. 2017 Dec;62(12):3298-3316. doi: 10.1007/s10620-017-4830-5. Epub 2017 Nov 6.

Recent Advances in the Pharmacological Management of Gastroesophageal Reflux Disease.

Kung YM1,2, Hsu WH1,3, Wu MC1,4, Wang JW1,4, Liu CJ1, Su YC1,3, Kuo CH1,3, Kuo FC5, Wu DC1,3,4, Wang YK6,7.

Author information

1
Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
2
Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, 100 Tz-You 1st road, Kaohsiung, 807, Taiwan.
3
Faculty of Medicine, Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
4
Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
5
School of Medicine, College of Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
6
Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. fedwang@gmail.com.
7
Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, 100 Tz-You 1st road, Kaohsiung, 807, Taiwan. fedwang@gmail.com.

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.

KEYWORDS:

Alginate; CB1 receptor agonist/antagonist; Gastroesophageal reflux disease; Histamine type-2 receptor antagonist; Proton pump inhibitor

PMID:
29110162
DOI:
10.1007/s10620-017-4830-5
[Indexed for MEDLINE]

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