Proton pump inhibitors in gastroesophageal reflux disease: a custom-tailored therapeutic regimen

Abstract

The Montreal Definition and Classification divides Gastroesophageal Reflux Disease (GERD) into esophageal symptomatic syndromes (and with mucosal damage) and extraesophageal syndromes (with acid established association and proposed association). In typical GERD symptoms, an 8-week treatment with PPIs is satisfactory in most cases (> 90%). Response rates to PPIs in GERD are highly variable, as they also rely on an appropriate clinical diagnosis of the disease; endoscopy differentiates the macroscopic GERD phenotype. The non-erosive variety (50-70% prevalence) has a different symptomatic response rate, as gastric acid is not the sole etiology of symptoms. The possible explanations of treatment failure include treatment adherence, PPI metabolism alterations and characteristics, and inadequate diagnosis. Refractory symptoms are related to gastric content neutralization by the chronic use of PPIs.Extraesophageal manifestations are associated with other pathophysiological mechanisms where an autonomic nervous system disturbance gives rise to symptoms. In these clinical entities, the relationship between symptoms and acid needs to be established in order to determine the use of PPIs, or consider other drugs. In other words, so as to "custom-tailor the best-fitting therapy" we need to answer the questions for whom, for what, how and for how long. Finally, PPI safety and tolerability are factors to be considered in elderly patients requiring chronic PPI use, who usually have chronic concomitant illnesses.

Inadequate prescription of chronic consumption of proton pump inhibitors in a hospital in Mexico: Cross-sectional study

“…Safety and tolerability of PPIs are factors to be considered in elderly patients requiring chronic use of PPIs, which usually have concomitant chronic diseases (10). Overall PPIs are a very safe drug with minor and infrequent side effects.…”

Updates on Management of GERD Disease

“…Antacids are OTC drugs (over the counter) used for treatment of occasional burning pain in the stomach and digestive difficulties. The proton pump inhibitors (PPIs inappropriately also known as Prazoli) are a group of molecules whose main action is a pronounced reduction of long duration (from 18 to 24 h) acidity of gastric juices [48]. The group of PPIs is the successor of H2 antihistamines (such as ranitidine) and are largely the most common of the latter for their increased effectiveness.…”

Cellular and molecular immunological mechanisms in eosinophilic esophagitis: an updated overview of their clinical implications

“…The influence of the PPI metabolism phenotype (i.e., CYP2C19 and CYP3A4 rapid/medium/slow metabolizers) [140] in the short-and long-term PPI response should be further addressed in EoE/PPI-REE patients.…”