Recent Advances in the Pharmacological Management of Gastroesophageal Reflux Disease

Kung, Yu-Min; Hsu, Wen‐Hung; Wu, Meng‐Chieh; Wang, Jiunn-Wei; Liu, Chung‐Jung; Su, Yu-Chung; Kuo, Chao‐Hung; Kuo, Fu‐Chen; Wu, Deng‐Chyang; Wang, Yao‐Kuang

doi:10.1007/s10620-017-4830-5

Cited by 19 publications

(13 citation statements)

References 186 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Additionally, we have demonstrated that cashew gum decreases inflammation in the esophagus and reverses the decrease in epithelial resistance and increase in mucosal permeability that is associated with esophageal inflammation in experimental NERD models 22 . Consequently, we believe cashew gum is a promising agent for the treatment of LPR, that may work through a regurgitation‐associated mechanism similar to alginate 33 . In this mechanism, the topical agent associated with gastric refluxate reaches the upper airway tract and forms a temporary shield, which increases the laryngeal pre‐epithelial defense.…”

Section: Discussionmentioning

confidence: 91%

“…22 Consequently, we believe cashew gum is a promising agent for the treatment of LPR, that may work through a regurgitation-associated mechanism similar to alginate. 33 In this mechanism, the topical agent associated with gastric refluxate reaches the upper airway tract and forms a temporary shield, which increases the laryngeal pre-epithelial defense.…”

Section: E893mentioning

confidence: 99%

See 1 more Smart Citation

Laryngeal Mucosa Alterations in Mice Model of Gastroesophageal Reflux: Effects of Topical Protection

Figueiredo

Sales

Nicolau³

et al. 2020

The Laryngoscope

View full text Add to dashboard Cite

Objectives/Hypothesis: The objectives of this study were to evaluate laryngeal inflammation and mucosal integrity in a murine model of reflux disease and to assess the protective effects of topical agents including alginate, hyaluronic acid, and cashew gum. Study Design: Animal study. Methods: A surgical murine model of reflux disease was evaluated at 3 or 7 days postsurgery, and laryngeal samples were collected to measure inflammation (wet weight and myeloperoxidase [MPO]) and mucosal integrity (transepithelial resistance [TER] and mucosal permeability to fluorescein). Additional groups of animals were administered one of several topical agents (alginate, hyaluronic acid, or cashew gum) daily, and laryngeal inflammation and mucosal integrity were evaluated at 3 days postsurgery. Results: At 3 days, and not 7 days postsurgery, we observed increased laryngeal wet weight and MPO, decreased laryngeal TER, and increased laryngeal mucosa permeability. Alginate partially decreased laryngeal inflammation (wet weight and not MPO) and dramatically improved laryngeal mucosal integrity. Conversely, hyaluronic acid eliminated the inflammation; however, it had no effect on laryngeal mucosal integrity impairment. Cashew gum eliminated laryngeal inflammation as well as the impairment in laryngeal mucosal integrity. Conclusions: This study shows that a surgical model of reflux disease induced laryngeal inflammation and impairment in laryngeal barrier function. These observed alterations were partially attenuated by alginate and hyaluronic acid and completely reversed by cashew gum.

show abstract

Section: Discussionmentioning

confidence: 91%

Section: E893mentioning

confidence: 99%

Laryngeal Mucosa Alterations in Mice Model of Gastroesophageal Reflux: Effects of Topical Protection

Figueiredo

Sales

Nicolau³

et al. 2020

The Laryngoscope

View full text Add to dashboard Cite

show abstract

“…To test the diffusion hypothesis, we conducted a series of studies with oesophageal preparations that were subjected to a suspension enriched with alginate, a topical oesophageal protectant that is currently used in clinical practice (Kung et al, 2017). Alginate appears to coat the luminal surface of the oesophagus, adhering to the mucosa as an additional barrier (Woodland et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Impairment of rat oesophageal muscle contractility associated with experimental non‐erosive oesophageal mucosal damage

Gadelha

Batista‐Lima

Oliveira

et al. 2018

Experimental Physiology

View full text Add to dashboard Cite

New Findings What is the central question of this study?Is the responsiveness of isolated segments of the rat oesophagus to contractile or relaxant stimuli susceptible to acute luminal exposure of the oesophagus to an acid solution that contains pepsin and bile salt? What is the main finding and its importance?The study reveals that luminal acidity is an important factor that disrupts barrier function in the oesophagus to allow the diffusion of noxious agents, such as bile acid, that alter the contractile status of the oesophageal body, even in the absence of inflammation. Abstract We investigated whether the experimental simulation of duodenogastro‐oesophageal reflux alters the contractile responsiveness of rat oesophageal strips. After 30 min of luminal exposure to a solution at acid pH that contained pepsin and taurodeoxycholic acid, isolated strips of the rat oesophagus and gastro‐oesophageal junction were subjected to contractile or relaxing stimuli. Acid challenge decreased the responsiveness of oesophageal strips to contractile stimulation, especially in oesophageal preparations that were mounted following the circular orientation of the muscularis externa layer. The contractility of longitudinal preparations of the rat oesophagus appeared less susceptible to the deleterious effects of acid challenge. In contrast, the responsiveness of ring‐like preparations from the gastro‐oesophageal junction to contractile stimulation was unaltered by acid challenge. Taurodeoxycholic acid decreased the responsiveness of circular oesophageal preparations to KCl, an effect that was exacerbated by luminal acidity. On the contrary, although the relaxant ability of the rat oesophagus did not change, acid challenge increased the relaxant efficacy of sodium nitroprusside and isoprenaline in strips of the gastro‐oesophageal junction. A significant decrease in transepithelial electrical resistance was seen when the oesophageal mucosa was challenged at pH 1 but not at pH 4. Treatment with alginate blunted the deleterious effects of acid challenge on transepithelial electrical resistance and the responsiveness of oesophageal preparations to KCl. The present findings support the notion that luminal acidity is an important factor that disrupts barrier function in the oesophagus to allow the diffusion of noxious agents, such as bile acid, that alter the contractile status of the oesophagus.

show abstract

“…The symptoms with the highest score were: heartburning, sensation of something sticking in the throat or a lump in the throat, and clearing throat, whereas breathing difficulties or choking episodes had the lowest score. The total score was 16 [14][15][16][17][18][19][20] in the EMERGE patients was significantly higher than in the RELIEFE patients: 16 [12][13][14][15][16][17][18][19][20] (p < 0.001; data not shown). Interestingly, RELIEF patients had significantly higher scores for some symptoms, including lump sensation, cough, dyspnea, hoarseness, and throat clearing, whereas EMERGE patients had higher scores for heartburn and difficult swallowing.…”

Section: Clinical Experiencementioning

confidence: 99%

“…Therefore, acid suppression is the mainstay of therapy for gastric reflux, and PPIs are the most effective drug in this approach [18,19]. Although PPIs are the treatment of choice for GERD, still approximately one-third of patients with GERD fail to respond symptomatically to a standard dose PPI, either partially or completely [20].…”

Section: Introductionmentioning

confidence: 99%

The Clinical Relevance of Gastroesophageal Reflux Disease and Laryngopharyngeal Reflux in Clinical Practice

Emanuele¹,

Giada²,

GiorgioCiprandi³

2018

Esophageal Cancer and Beyond

View full text Add to dashboard Cite

Gastric reflux may be considered a para-physiological event that may occur up to 50 times a day. It usually happens when gas (less commonly liquids) flow back from stomach into esophagus. However, when defense mechanisms leave, disease may progress. If the esophagus is the trigger, gastroesophageal reflux disease (GERD) emerges. The prevalence of GERD in the primary care setting seems to be even more evident when one considers that, in the United States, 4.6 million office encounters annually are primarily for GERD, whereas 9.1 million encounters include GERD in the top 3 diagnoses for the encounter. GERD constitutes also the most frequently first-listed gastrointestinal diagnosis in ambulatory care visits. In addition, the extraesophageal manifestations of reflux, including LPR, asthma, and chronic cough, have been estimated to cost $5438 per patient in direct medical expenses in the first year after presentation and $13,700 for 5 years. Presently, the newest alginate compounds renowned the interest in this attracting and stimulating area. In this regard, a new medical device (Marial®), unique still now possessing the indication for both GERD and LPR, has been recently launched in the Italian market, two large surveys were conducted in Italy: RELIEF, involving 86 otolaryngologists, and EMERGE, involving 56 gastroenterologists. The aims of these surveys were: (1) to define clinical characteristics, including previous treatment, of the patients referred to consultation; (2) to evaluate the reliability of RFS, GIS, and RSI questionnaires in real-world settings, such as specialist office; and (3) to investigate the patients' perception of efficacy of the prescribed therapy, based on the best practice and considering also the new medical device Comparing the patients' perception of treatment efficacy, reduction in RSI values for each single symptom before and after a 4 week-treatment with Marial® alone or with PPI in add-on in EMERGE and RELIEF patients are reported. Marial® alone treatment induced a statistically significant higher reduction in each single symptom in RELIEF patients than in EMERGE patients, with the exception of heartburn, chest pain, indigestion, or stomach

show abstract

Recent Advances in the Pharmacological Management of Gastroesophageal Reflux Disease

Cited by 19 publications

References 186 publications

Laryngeal Mucosa Alterations in Mice Model of Gastroesophageal Reflux: Effects of Topical Protection

Laryngeal Mucosa Alterations in Mice Model of Gastroesophageal Reflux: Effects of Topical Protection

Impairment of rat oesophageal muscle contractility associated with experimental non‐erosive oesophageal mucosal damage

The Clinical Relevance of Gastroesophageal Reflux Disease and Laryngopharyngeal Reflux in Clinical Practice

Contact Info

Product

Resources

About