Treatment of gastroesophageal reflux disease.
OBJECTIVE
To review the literature on the treatment of gastroesophageal reflux disease (GERD) with emphasis on pharmacological aspects. To identify particularities of pharmacological treatment of esophageal and extraesophageal manifestations of the disease.


METHODS
Electronic search of the PubMed/MEDLINE and Cochrane Collaboration databases. Controlled and randomized studies published since 2000 and reviews representing consensus positions and directives published within the last 10 years were identified.


RESULTS
The drugs currently available for the treatment of GERD do not act in the primary mechanism of the disease, i.e. transitory relaxation of the lower esophageal sphincter. Pharmacological treatment of GERD with symptoms or with esophageal injury is based on the suppression of acid secretion, particularly with proton pump inhibitors. When the hyperreactivity of the lower airways coexists with esophageal GERD symptoms, suppression of acid secretions should be of benefit in managing the respiratory disease in the presence of a causal relationship; however, this is not usual. When esophageal symptoms are not present, esophageal 24-hour pH study should be carried out prior to starting pharmacological treatment for GERD. Improvement of respiratory symptoms may be delayed with relation to esophageal symptoms. It is common for GERD to recur and pharmacological treatment should be repeated or continued indefinitely, depending on clinical presentation of the disease.


CONCLUSIONS
The strategies that have been proposed for the pharmacological treatment of GERD in children are primarily based on studies of case series or on studies with adults. There have been very few controlled and randomized studies in children. Undertaking a greater number of these studies might reinforce existing aspects or establish new aspects of management.
Guimarães
Elizabet Vilar
EV
Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil. pcamargs@medicina.ufmg.br
Marguet
Christophe
C
Camargos
Paulo Augusto Moreira
PA
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use*; D015746:Abdominal Pain / Q000188:drug therapy; D000293:Adolescent; D000328:Adult; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001471:Barrett Esophagus / Q000188:drug therapy / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D004940:Esophageal Stenosis / Q000188:drug therapy / Q000209:etiology; D004941:Esophagitis / Q000188:drug therapy / Q000209:etiology; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy*; D006635:Histamine H2 Antagonists / Q000494:pharmacology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D064747:Lansoprazole; D008019:Life Style; D009853:Omeprazole / Q000627:therapeutic use*; D054328:Proton Pump Inhibitors; D017494:Proton Pumps / Q000494:pharmacology; D013577:Syndrome; D014839:Vomiting / Q000188:drug therapy
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D017494:Proton Pumps; D064747:Lansoprazole; D009853:Omeprazole