Gastrointestinal symptoms associated with gastroesophageal reflux disease, and their relapses after treatment with proton pump inhibitors: A systematic review

Abstract

Gastroesophageal reflux disease (GERD) is a common functional gastrointestinal disorder with significant effects on the quality of life. The burden of GERD is soaring in Asia. Preventing symptom relapse is a therapeutic goal in GERD patients. Since proton pump inhibitors (PPI) are the first-line treatment of GERD, drug failure has become a major problem in the treatment procedure. We reviewed the literature in order to find articles related to comorbidities and symptoms affecting GERD from 1980 to 2015 via PubMed and Google Scholar using keywords such as ‘Gastroesophageal reflux disease’, ‘Gastrointestinal symptoms’ and Boolean operators (such as AND, OR, NOT). Due to the cost of PPI therapy and the high rate of GERD relapse after PPI therapy, demand for continuing this type of treatment is decreasing. Thus, we need to discover new approaches to treat the disease and also investigate the relationship between the treatment of GERD and its comorbidities and symptoms such as functional constipation.

Key Considerations From a Health Authority Perspective When Proton Pump Inhibitors Are Used to Treat Gastroesophageal Reflux Disease (GERD) and Their Implications

“…Antacids, alginates, histamine (H 2 ) receptor blockers, or proton pump inhibitors (PPIs) are typically a first-line medical treatment for patients with GERD [ 1 , 38 - 40 ]. In recent years, PPIs, e.g., omeprazole, which work by covalently binding to the proton pumps that control the final step of gastric acid production, thereby decreasing it, have become the treatment of choice for patients with GERD, with a number of studies showing superiority over H 2 receptor blockers [ 5 , 38 , 41 - 49 ]. Typically, a standard dose of a PPI provides complete relief in approximately 70 to 80% of patients with GERD within a week [ 1 , 50 - 53 ], with limited differences in effectiveness between twice-daily and once-daily PPIs [ 54 ].…”

Efficacy of Chinese Herbal Formula Sini Zuojin Decoction in Treating Gastroesophageal Reflux Disease: Clinical Evidence and Potential Mechanisms

“…However, patients with long-term medication need to be alert and monitored for adverse drug reactions. Evidence (Hosseini et al, 2017) shows that even if PPI is gradually reduced during the course of treatment, the recurrence rate does not change much in the short term, whereas the corresponding gastrointestinal symptoms will increase, such as dyspepsia and irritable bowel syndrome. In addition, recent large-scale association studies based on the evaluation of prescription databases (Gyawali, 2017) have shown that the long-term use of PPI can lead to adverse reactions such as bacterial gastroenteritis, microscopic colitis, acute interstitial nephritis, fundic gland polyps, and hypomagnesemia.…”

Study on the Therapeutic Effects of Drug and Cognitive-Behavioral Therapy on Non-Erosive Reflux Disease Patients With Emotional Disorders

“…Because current conventional drug treatment mainly addresses the symptoms rather than the pathogenesis, the drugs for treating NERD are constantly updated, but the treatment effect is not satisfactory. A study by Yu et al ( 18 , 19 ) shows that the combination of conventional drugs (esomeprazole) with antidepressants or anxiolytics (flupentixol and melitracen) in the treatment of GERD was superior to esomeprazole alone. However, clinical trials have shown that the side effects of even low doses of antidepressants and anti-anxiety drugs limit the widespread use of this combination for the treatment of NERD.…”