title: 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.
authors: Department of Endoscopy, Hospital Ángeles del Pedregal, Instituto Nacional de Cancerología, Mexico, D.F. ssobrinocossio@prodigy.net.mx
authors: Sergio
authors: S
authors: Sobrino-Cossío
authors: Juan Carlos
authors: JC
authors: López-Alvarenga
authors: José María
authors: JM
authors: Remes-Troche
authors: Elymir Soraya
authors: ES
authors: Galvis-García
authors: Julio César
authors: JC
authors: Soto-Pérez
authors: Oscar
authors: O
authors: Teramoto-Matsubara
authors: Miguel
authors: M
authors: Morales-Arámbula
authors: Antonio
authors: A
authors: Orozco-Gamiz
authors: José Luis
authors: JL
authors: Tamayo de-la-Cuesta
authors: Gualberto
authors: G
authors: Mateos
authors: Arturo
authors: A
authors: Jiménez
authors: Adolfo
authors: A
authors: Sáez
authors: José Antonio
authors: JA
authors: Vargas
mesh_terms: D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics; D003362:Cost-Benefit Analysis; D065731:Cytochrome P-450 CYP2C19; D004347:Drug Interactions; D005744:Gastric Acid; D005750:Gastric Juice / Q000187:drug effects; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000191:economics / Q000235:genetics; D005819:Genetic Markers; D006801:Humans; D011110:Polymorphism, Genetic; D057285:Precision Medicine; D054328:Proton Pump Inhibitors / Q000191:economics / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005819:Genetic Markers; D054328:Proton Pump Inhibitors; D001189:Aryl Hydrocarbon Hydroxylases; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19