Pathophysiology and Pharmacological Treatment of Gastroesophageal Reflux Disease

Abstract

Gastroesophageal reflux disease (GERD) is one of the most common diagnoses in a gastroenterologist’s practice. Gastroesophageal reflux describes the retrograde movement of gastric contents through the lower esophageal sphincter (LES) to the esophagus. It is a common, normal phenomenon which may occur with or without accompanying symptoms. Symptoms associated with GERD include heartburn, acid regurgitation, noncardiac chest pain, dysphagia, globus pharyngitis, chronic cough, asthma, hoarseness, laryngitis, chronic sinusitis and dental erosions. The introduction of fiberoptic instruments and ambulatory devices for continuous monitoring of esophageal pH (24-hour pH monitoring) has led to great improvement in the ability to diagnose reflux disease and reflux-associated complications. The development of pathological reflux and GERD can be attributed to many factors. Pathophysiology of GERD includes incompetent LES because of a decreased LES pressure, transient lower esophageal sphincter relaxations (TLESRs) and deficient or delayed esophageal acid clearance. Uncomplicated GER may be treated by modification of life style and eating habits in an early stage of GERD. The various agents currently used for treatment of GERD include mucoprotective substances, antacids, H2 blockers, prokinetics and proton pump inhibitors. Although these drugs are effective, they do not necessarily influence the underlying causes of the disease by improving the esophageal clearance, increasing the LESP or reducing the frequency of TLESRs. The following article gives an overview regarding current concepts of the pathophysiology and pharmacological treatment of GERD.

Efficacy of Rabeprazole in the Treatment of Symptomatic Gastroesophageal Reflux Disease

“…PPIs are currently the most potent agents available for the relief of the symptoms of GERD, regardless of the presence or absence of esophagitis (22)(23)(24)(25)(26)(27). In the present analysis, rabeprazole was shown to provide rapid, statistically significant relief of heartburn and, in many cases, full resolution of heartburn in patients with nonerosive reflux disease.…”

Zapalne i nowotworowe zmiany błony śluzowej krtani w chorobie refluksowej

“…Istnieje takŜe wiele substancji w diecie a takŜe leków, które poprzez zmniejszenie napięcia LES mogą przyczyniać się do rozwoju GERD. NaleŜą do nich: kofeina, alkohol, coca-cola, mięta, wyroby tytoniowe oraz blokery kanału wapniowego, beta-mimetyki, nitraty, pigułki antykoncepcyjne (progesteron) i atropina [39]. LES ulega rozkurczowi takŜe w odpowiedzi na perystaltykę przełykową umoŜliwiając pasaŜ śliny, płynów i pokarmów do Ŝołądka.…”

“…W patomechanizmie GERD nie naleŜy zapominać takŜe o roli zwięk-szonego ciśnienia śródbrzusznego, które indukuje chorobę refluksową. Dzieje się tak równieŜ w ciąŜy (działanie progesteronu), u osób otyłych i podczas spoŜywa-nia napojów gazowanych [39].…”

Gli inibitori della pompa protonica nelle patologie acido correlate: il ruolo di rabeprazolo in una strategia di cost-minimisation

“…Uno studio accurato della letteratura sull'argomento mostra come sia diffusa la consapevolezza nella classe medica di una simile efficacia fra i diversi IPP [9,10]. In generale, dosi standard di IPP (20 mg per omeprazolo, 30 mg per lansoprazolo, 40 mg per pantoprazolo, 20 mg per rabeprazolo e 40 mg per esomeprazolo) somministrate prima di colazione alleviano i sintomi e curano l'esofagite di ogni grado in circa l'85 -90 % dei pazienti [11].…”