Treatment of gastroesophageal reflux disease in adults: an individualized approach

Digestive Diseases
Jean Paul Galmiche, Kate Stephenson

Abstract

Until the 1990s, most therapeutic trials in gastroesophageal reflux disease (GERD) focussed upon endoscopic lesions. In fact the correlation between patient symptoms and both the presence and grade of esophagitis is very poor. The classical criteria for the assessment of therapeutic efficacy in GERD have therefore been revised, and there is now a consensus that the relief of symptoms and the long-term control of the disease are the primary aims of therapy for the majority of patients. Proton pump inhibitors (PPIs) represent the mainstay of therapy for patients with non-erosive reflux disease (NERD) as well as esophagitis. Although a stepwise strategy has been recommended in the past, a step-down strategy (starting with a full-dose PPI) appears to be a more cost-effective approach. There are as yet insufficient data to establish the clear superiority of one PPI over others. PPIs have a number of limitations. Symptom relief is significantly inferior in NERD than in erosive esophagitis. The heterogeneity of the NERD group may be one of the most influential factors, but the role of esophageal hypersensitivity has been suggested especially in patients with normal acid exposure. The role of non-acid reflux should also be scrutinized....Continue Reading

Citations

Dec 1, 2008·Clinical Journal of Gastroenterology·Hiroto MiwaTakayuki Matsumoto
Oct 26, 2006·Journal of Clinical Gastroenterology·Akihito NagaharaNobuhiro Sato
Nov 5, 2011·Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus·N ManabeS Tanaka
Nov 9, 2016·BMC Medicine·Carmelo ScarpignatoUNKNOWN Italian Society of Pharmacology, the Italian Association of Hospital Gastroenterologists, and the Italian Federation of Gene

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