Medical therapy of gastroesophageal reflux disease.
OBJECTIVE
Proton pump inhibitors remain the mainstay of medical therapy in gastroesophageal reflux disease. Despite their increasing use, up to 40% of patients are not fully satisfied with their antireflux therapy. Recent data on efficacy and safety are reviewed and causes of failure are discussed.


RESULTS
Several randomized studies and a metaanalysis have shown marginal differences in efficacy between various proton pump inhibitor regimens. In subgroups, however, such as severe esophagitis, esomeprazole may be superior. Poor compliance is one of the main causes of failure. Nonacid reflux is likely to play an important role, especially in patients with regurgitation or cough persisting on therapy. Genetic polymorphisms involved in proton pump inhibitor metabolism, Helicobacter pylori infection or nocturnal acid breakthrough during therapy are probably less important than initially suspected. Recent pharmacological developments include new proton pump inhibitor isomers, potassium competitive acid blockers and inhibitors of transient lower esophageal sphincter relaxations.


CONCLUSIONS
There are still important unmet needs in the treatment of gastroesophageal reflux disease. Optimizing acid control is unlikely to improve the condition of the majority of patients with incomplete proton pump inhibitor response. Inhibition of transient lower esophageal sphincter relaxations remains the major pharmacological target for future drug development.
Coron
Emmanuel
E
Department of Gastroenterology and Hepatology, University Hospital, Nantes, France. emmanuel.coron@chu-nantes.fr
Hatlebakk
Jan G
JG
Galmiche
Jean-Paul
JP
D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001418:Baclofen / Q000627:therapeutic use; D015444:Exercise; D005638:Fruit; D005764:Gastroesophageal Reflux / Q000628:therapy*; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D008019:Life Style; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D000069463:Olive Oil; D010938:Plant Oils / Q000627:therapeutic use; D054328:Proton Pump Inhibitors; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use
D000897:Anti-Ulcer Agents; D007211:Indoles; D009125:Muscle Relaxants, Central; D000069463:Olive Oil; D010938:Plant Oils; D054328:Proton Pump Inhibitors; D017366:Serotonin Receptor Agonists; C105050:tegaserod; D001418:Baclofen