Gastroesophageal reflux disease: pathophysiology a... [J Assoc Acad Min... http://www.ncbi.nlm.nih.

gov/pubmed/10826019

U.S. National Library of Medicine

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J Assoc Acad Minor Phys. 2000;11(1):7-11.

Dajani EZ.
International Drug Development Consultants (IDDC) Corporation, Long Grove, Illinois 60047-9532, USA. esamd@aol.com

Abstract
Gastroesophageal reflux disease (GERD) is one of the most frequently encountered illnesses in the Western Hemisphere.
GERD encompasses a spectrum of disorders in which reflux of gastric content into the esophagus causes symptoms
and/or damage to the esophagus, oropharynx, or respiratory tract. This article provides a brief update on the
pathophysiology and pharmacology of drugs used for the treatment of GERD. The etiology of GERD is multi-factorial and
is believed to be principally a consequence of altered motility states in the esophagus and stomach. The drugs used for
the treatment of GERD are continuously evolving, but as yet no drug has been shown to cure this chronic, relapsing
disease. Antacids, prokinetics, and gastric antisecretory agents are the principal drugs currently used to treat GERD in
conjunction with life-style modifications. Due to their ultrashort duration of buffering action, antacids are primarily used as
self-medication for temporary relief of mild GERD symptoms. The prokinetic drug cisapride effectively resolves symptoms
and heals mild-to-moderate esophagitis, with efficacy similar to that of the histamine H2-receptor antagonists. H2-receptor
antagonists exhibit moderate inhibition of gastric acid secretion and are effective for resolving symptoms and healing
mild-to-moderate esophagitis. In addition, H2-receptor antagonists slightly augment the therapeutic efficacy of cisapride
for healing mild-to-moderate esophagitis. However, use of H2-receptor antagonists at higher doses and higher frequency
approaches the efficacy of proton pump inhibitors in healing erosive esophagitis. Given their potent and long-lasting
acid-reducing efficacy, proton pump inhibitors have become the drugs of choice for many patients with GERD. Despite
progress in the medical treatment of GERD, there are still several unresolved questions relating to cost-effective
strategies with specific drugs, how long pharmacologic therapy should be maintained, and when surgical intervention is
warranted. Additional studies are clearly needed to address the unresolved treatment issues in GERD.

PMID: 10826019 [PubMed - indexed for MEDLINE]

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