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Gastro-esophageal reflux disease (GERD) is a highly prevalent, chronic disorder, whose knowledge remains limited and the management of these patients changes continuously. This review provides a summary of the most recent advancements in the pathogenesis of this disease and the new drugs introduced into the market to overcome some of the unmet need...
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Gastroesophageal reflux disease (GERD) is a condition in which gastric contents regurgitate into the esophagus or beyond, resulting in either troublesome symptoms or complications. GERD is heterogeneous in terms of varied manifestations, test findings, and treatment responsiveness. GERD diagnosis can be established with symptomatology, pathology, o...
Citations
... The pathophysiology of GERD is multifactorial [6] and it is linked to a misbalance between the aggressiveness of the gastric refluxate into the oesophagus or adjacent organs, and the failure of protective mechanisms, such as the buffering capacity of oesophageal epithelial cells [7], that results in symptoms such as heartburn, regurgitation, and chest pain. Symptomatic relief from GERD can be achieved by means of pharmacological treatments with proton pump inhibitors (PPIs), histamine-2 receptors antagonists, and Nutrients 2024, 16, 1759 2 of 10 antacids [8], each of which, being characterized by different mechanisms of action aiming at the neutralization of gastric acid and/or at the suppression of its production, must be specifically chosen according to the peculiar features of the disease. In fact, although PPIs represent the standard of care for GERD, they may not be effective for non-erosive reflux disease (NERD) [9]; PPIs and histamine-2 receptor antagonists show a limited efficacy when intermittently used [10] and exhibit relevant adverse effects; and antacids also present adverse effects and limitations of use in specific cases [11]. ...
Dietary interventions represent an interesting alternative to pharmacological treatments for improving the quality of life (QoL) of subjects suffering from gastroesophageal reflux disease (GERD). This randomized, double-blind, placebo-controlled study aimed to evaluate the efficacy of a food supplement (FS) containing a probiotic strain, bioactive peptides, and vitamins in relieving heartburn/dyspeptic symptoms in subjects with mild-to-moderate GERD. Fifty-six adult participants were randomly assigned to receive the placebo or the active FS for 28 days. Subjects were asked to record daily the frequency and intensity of heartburn episodes and the intake of over- the-counter (OTC) medications. GERD-QoL and self-assessment questionnaires were also completed every two weeks and at the end of the treatment, respectively. FS was effective in achieving a progressive and significant reduction of heartburn frequency and severity, with an intergroup significant difference at the end of the treatment period. FS group also reported a reduction in the OTC medication intake, whereas placebo administration did not modify the OTC intake. Results from the QoL and self-assessment questionnaires showed that FS administration achieved a progressive and statistically significant intragroup and intergroup improvement in the QoL score and a higher positive response with respect to the placebo treatment.
... Since it is a known fact that the pathogenesis of GERD is a disordered function of the lower esophageal sphincter, the use of a prokinetic agent in such patients seems logical 13 . Prokinetics activate serotonergic or dopaminergic receptors to increase esophageal and gastric peristalsis, which aids in esophageal clearance 9,14 . This is particularly crucial for individuals with GERD characterized by transient lower esophageal sphincter relaxation (TLESR), which refers to spontaneous lower esophageal sphincter relaxation unrelated to swallowing and plays a pivotal role in GERD patients. ...
Sodium alginate helps manage and treat heartburn and gastroesophageal reflux disease (GERD). This article discusses thestructure, mechanism of action and clinical application. A brief review of the literature is carried out.
... Dentre os impactos físicos dessa doença no público estudado, evidencia-se principalmente as lesões da mucosa esofagiana, que vão desde a esofagite de refluxo até condições mais graves como o esôfago de Barrett, desenvolvido por cerca de 15% dos pacientes ao longo da vida e adenocarcinoma, tendo uma chance de 5 a 7 vezes maior de desenvolver adenocarcinoma esofágico (GROULX et al., 2020;SAVARINO et al., 2021). ...
... As principais complicações associadas à DRGE são: tosse crônica, pneumonia recorrente, esôfago de Barrett e sua possível evolução para o adenocarcinoma de esôfago entre outros. Como resultado da sua manifestação, quando não tratados, os indivíduos acometidos têm prejuízos importantes na qualidade de vida, podendo alguns desses prejuízos gerar até mesmo um efeito de feedback positivo sobre a doença: diminuição da qualidade do sono, efeitos negativos na realização de suas atividades laborais e sociais, problemas com a alimentação e consequente impacto financeiro em virtude do gasto com medicações, consultas e perda de horas de trabalho (COELHO et al. 2022;SAVARINO et al., 2021). ...
... Observaram forte evidência ao correlacionar DRGE à presença de sintomas como asma, tosse crônica e rouquidão. Neste estudo, a prevalência de sintomas atípicos como soluços (11%), asma (8,6%) e pigarro (12%), já descritos em outros estudos (SAVARINO et al., 2021;GUIMARÃES et al., 2023) foram os mais frequentes. ...
Introdução: A Doença do Refluxo Gastroesofágico (DRGE) é atualmente uma das patologias mais prevalentes na gastroenterologia e otorrinolaringologia, com incidência média, no Brasil, em torno de 12 a 20%. A sintomatologia é variada, o que dificulta inicialmente um diagnóstico mais preciso. Seus sintomas podem se manifestar de forma típica e atípica, podendo gerar impacto na qualidade de vida das pessoas. Objetivo: Investigar sintomas típicos e atípicos da Doença do Refluxo Gastroesofágico em estudantes de Medicina. Metodologia: Estudo transversal do tipo Survey, observacional e descritivo realizado na Universidade Tiradentes, no período de fevereiro a abril de 2024. A amostra foi constituída por 151 alunos do curso de medicina da Universidade Tiradentes, campus Aracaju e Campus Estância, no estado de Sergipe. Resultados: Afirmaram ter diagnóstico de DRGE 35 participantes. O sexo feminino representou 83% do total da amostra (151), sendo que 77% tinham diagnóstico prévio de DRGE. Sintomas típicos como pirose e regurgitação foram mais prevalentes, e sintomas atípicos foram representados pela presença de pigarro, soluços, sintomas de asma e tosse crônica. Foi frequente a associação de DRGE com histórico familiar da doença, transtornos psiquiátricos, consumo de cafeína e alguns medicamentos. Conclusão: Sintomas típicos e atípicos foram prevalentes entre estudantes de medicina, principalmente no sexo feminino e em indivíduos de pele branca. Vários fatores de risco foram identificados, o que requer atenção ao impacto na qualidade de vida nessa população acadêmica.
... 9,12,13 However, a substantial proportion of GERD patients, between 20% and 40%, continue to experience symptoms despite medical treatment. [14][15][16][17] Nonpharmacological approaches, including weight management, avoiding trigger foods, and moderate alcohol and smoking consumption, can play a complementary role in managing PPI-refractory GERD symptoms. 13,18 On the other hand, several adjunctive pharmacological treatments have been suggested in PPI-non-responder patients. ...
... These findings are consistent with several studies highlighting that a combination of different compounds with anti-reflux or antiacid drugs is more effective than controlling esophageal acid exposure in GERD patients. 15,[52][53][54][55] Moreover, the addition of a bioadhesive mixture to the pharmacological formulation seems to provide an advantage in terms of both symptom severity and impact on quality of life. It is known that an important limitation of the medications that promote anti-reflux and enhance barrier integrity is the short-term efficacy due to the physiological clearing mechanism of the esophagus. ...
Background
Gastroesophageal reflux disease (GERD) is a challenging condition that involves different physicians, such as general practitioners (GPs), gastroenterologists, and ears, nose and throat (ENT) specialists. A common approach consists of proton-pump inhibitors (PPIs) administration. Adjunctive pharmacological treatment may have a role in the management of non-responders to PPIs.
Objectives
We aimed to survey GPs and different medical specialists to investigate the medical approaches to patients reporting GERD symptoms. In addition, we examined the use of adjunctive pharmacological treatments in patients with GERD symptoms who do not respond to PPIs.
Design
Retrospective observational study.
Methods
A survey was conducted among a large sample of gastroenterologists, GPs, and ENT specialists. Symptoms were divided into typical and extraesophageal, and their severity and impact on quality of life were explored with the GERD Impact Scale and with Reflux Symptom Index (RSI). All therapies administered usually for GERD were investigated.
Results
A total of 6211 patients were analyzed in this survey. Patients with typical symptoms were 53.5%, while those with extraesophageal symptoms were 46.5%. The latter were more frequently reported by ENT patients (53.6%, p < 0.0001). The GSI was higher in patients followed by gastroenterologists (9 points) and GPs (9 points) than ENT specialists (8 points), but the RSI was higher in the ENT group (14.3 ± 6.93) than in GPs and gastroenterologist groups (10.36 ± 6.36 and 10.81 ± 7.30, p < 0.0001). Chest pain had the highest negative impact on quality of life (p < 0.0001). Of the 3025 patients who used PPIs, non-responders showed a lower GSI when treated with a combination of adjunctive pharmacological treatments and bioadhesive compounds, than with single-component drugs.
Conclusion
Patients with GERD referred to a gastroenterologist had more severe disease and poorer quality of life. The combination of adjunctive pharmacological treatments and bioadhesive compounds seems to be effective in the management of PPI refractory patients.
... The first intervention in patients with refractory GERD is to optimize PPI therapy: improvement of >50% of symptoms was observed in 11-35% of patients when PPI use was optimized (62,63) . It is important to ensure that the patient takes the medication regularly daily, 30-60 minutes before the first meal of the day or before breakfast and dinner, and if the drug is correctly administered 2 times a day (7,60) . ...
... The phenomenon of postprandial reflux is due to the formation of a gastric acid pocket, a true layer of gastric juice that sits above the ingested food bolus and below the esophagogastric junction. Studies have shown that alginate is capable of neutralizing or relocating the acid contained in this pocket, thus preventing postprandial reflux (62) . ...
Background
Gastroesophageal Reflux Disease (GERD) is a prevalent condition in Brazil, affecting 12% to 20% of the urban population, with significant implications for patient quality of life and potential for complications.
Objective
This paper focuses on the recent update of the Brazilian guidelines for GERD, a necessary revision due to advancements in knowledge and practice since the last publication over a decade ago. The update pays particular attention to the role and safety of proton pump inhibitors (PPIs), acknowledging the growing concerns about their long-term use, adverse events, and overprescription.
Methods
The methodology of the guideline update involved an extensive literature review in multiple languages (English, French, Italian, Spanish, and Portuguese), drawing from major databases such as Medline, Embase, and SciELO-Lilacs.
Results
This comprehensive approach resulted in a carefully curated selection of studies, systematic reviews, and meta-analyses, specifically focusing on PPIs and other therapeutic strategies for GERD. The updated guidelines are presented in a user-friendly question-and-answer format, adhering to the PICO system (Population, Intervention, Comparison, Outcomes) for clarity and ease of interpretation. The recommendations are supported by robust scientific evidence and expert opinions, enhancing their practical applicability in clinical settings. To ensure the reliability and clarity of the recommendations, the GRADE system (Grading of Recommendations Assessment, Development, and Evaluation) was employed. This system categorizes the strength of recommendations as strong, weak, or conditional and classifies evidence quality as high, moderate, low, or very low. These classifications provide insight into the confidence level of each recommendation and the likelihood of future research impacting these guidelines.
Conclusion
The primary aim of these updated guidelines is to offer practical, evidence-based advice for the management of GERD in Brazil, ensuring that healthcare professionals are equipped with the latest knowledge and tools to deliver optimal patient care.
Keywords:
Reflux disease; consensus; guidelines
... In retrospect, a couple of factors caused difficulty in diagnosing gastrinoma. First, GERD is a common disease; incidence rates are reported to be 20% in Western countries [4] and 15% in Japan [5]. Clinicians know that gastrinomas cause GERD syndromes, but are rarely encountered in routine practice; therefore, it is not a disease to be routinely ruled out. ...
Gastrinomas are pancreatic or duodenal endocrine tumors that secrete excess gastrin, which causes gastroesophageal reflux disease, peptic ulcers, and chronic diarrhea. Due to the rarity of the disease, nonspecific symptoms, and the outstanding effect of proton pump inhibitors, diagnosing gastrinomas is difficult. Here, we present the case of a 58-year-old woman who had a duodenal gastrinoma that caused rare but critical events, including esophageal perforation, necrotizing esophagitis, and severe esophageal stricture. She presented with a non-malignant severe lower esophageal stricture, which was resistant to endoscopic dilatation. During esophagectomy, a duodenal mass was excised and diagnosed as gastrinoma. This was considered the main cause of all events. Gastrinomas are rarely encountered in clinical practice, but early diagnosis is necessary to avoid serious conditions. Therefore, whenever we encounter a patient with gastroesophageal reflux disease requiring long-term treatment or is refractory, we must not forget to screen for gastrinomas.
... 13 Prokinetics activate serotonergic or dopaminergic receptors to increase esophageal and gastric peristalsis, which aids in esophageal clearance. 9,14 This is particularly crucial for individuals with GERD characterized by transient lower esophageal sphincter relaxation (TLESR), which refers to spontaneous lower esophageal sphincter relaxation unrelated to swallowing and plays a pivotal role in GERD patients. ...
Sodium alginate helps manage and treat heartburn and gastroesophageal reflux disease (GERD). This article discusses thestructure, mechanism of action and clinical application. A brief review of the literature is carried out.
... This technique is primarily employed for the purpose of diagnosing esophageal dynamic abnormalities. Additionally, it can be utilized to aid in the diagnosis of systemic diseases that are accompanied by esophageal movement disorders such as scleroderma and dermatomyositis [17]. Furthermore, it can be employed to assess the impact of specific surgical procedures, such as esophageal dilatation for achalasia of the esophagus or diffuse esophageal spasm, lower esophageal sphincterotomy, or surgical fundoplication for reflux esophagitis [18]. ...
Background: Esophageal manometry (EM) and proton pump inhibitor (PPI) tests are used to see how well they could diagnose GERD-related chest pain that is not caused by the heart diseases.
Methods: Randomly, 21 cases of GERD-related NCCP and 8 cases of non-GERD-related NCCP were assigned into two groups of total 29 patients with NCCP. General information, esophageal dynamic indices, and the diagnostic effectiveness of PPI in patients from various groups were observed and documented.
Results: The lower esophageal sphincter (LES) pressure at rest was found to be significantly lower in patients with non-cardiac chest pain (NCCP) caused by GERD than in patients with NCCP not caused by GERD. The mean LES resting pressure and mean residual pressure were also lower in the GERD related NCCP group. Additionally, the maximum residual pressure was lower in the GERD-related NCCP group. These differences between the two groups were statistically significant, with a p-value less than 0.05. The PPI test yielded a sensitivity of 78.95%, a specificity of 83.33%, a positive predictive value (PPV) of 93.75%, and a negative predictive value (NPV) of 55.56% in relation to non-cardiac chest pain (NCCP) associated with gastro esophageal reflux disease (GERD). Conclusion: In summary, the utilization of high-resolution esophageal manometry (EM) has demonstrated significant diagnostic utility in the context of non-cardiac chest pain (NCCP). The strategic use of antispasmodic medications has the potential to alleviate symptoms experienced by individuals with non-cardiac chest pain (NCCP) and enhance their overall quality of life (QOL). Also, the proton pump inhibitor (PPI) test is widely thought to be the best way to diagnose non- cardiac chest pain (NCCP) caused by gastro-esophageal reflux disease (GERD) in a clinical setting.
... The management of these individuals necessitates testing and the avoidance of empiric therapies, which are frequently ineffective, expensive, and possibly harmful. In randomized clinical trials, new medications have shown promising effects [19]. ...
Our comprehensive systematic review aimed to examine gastroesophageal reflux disease (GERD), a disorder that occurs when stomach contents flow back into the esophagus. It may manifest as either non-erosive reflux disease or erosive esophagitis. The activity depicts the assessment and medical management of GERD and emphasizes the interprofessional team's involvement to enhance care for people with this ailment. Data sources were PubMed/Medline and Embase. Our review investigated English-language articles (from 2014 to 2023) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Overall, there were seven articles. Surveys and analyses of national databases were the most widely used methods (n=7). The search identified 3,730 studies, and seven were eligible for inclusion in the analysis. Further understanding of GERD and treatment protocols may help improve evaluation and management in the future. Millions of individuals worldwide suffer from GERD, a common clinical condition. Patients can be identified by symptoms that are both common and uncommon. For many GERD patients, acid suppression treatment reduces symptoms and avoids clinical complications. Our capacity to recognize and treat disease consequences has improved with the advancement of diagnostic and treatment methods. Here, we go into the etiology and consequences of GERD and offer details on the treatment strategy for this prevalent illness.
... Ключові слова: цитопротекція, слизова оболонка шлунка, ерозивно-виразкові ураження, гастроезофагеальна рефлюксна хвороба, комплекс полісахаридів зі стебел опунції індійської (Opuntia ficus-indica), листя маслини європейської (Olea europaea), суміш альгінату натрію та солей, екстракт листя калачиків лісових (Malva sylvestris). Полтавський державний медичний університет слизової оболонки, найпоширенішими з яких є рефлюкс-езофагіт, стриктури, стравохід Барретта й аденокарцинома [28]. ...
The analysis of publications is devoted to the problem of treatment and prevention of gastroesophageal reflux disease with the use of cytoprotectors. Special attention is paid to Gastrotop, the new complex of plant origin. Gastrotop (Еrвоzета S.p.A, San Marino) is a new medication with cytoprotective action, containing Mucosave CG, a standardized complex of polysaccharides from the stems of Indian prickly pear (Opuntia ficus‑indica, 33.5%), leaves of European olive (Olea europaea, 24.0%); a mixture of sodium alginate and salts (sodium alginate — 50 mg, potassium bicarbonate — 10 mg, calcium carbonate — 10 mg), an extract of the leaves of Malva sylvestris L. 50 mg. Its action is aimed at the increasing of protection of esophageal and gastroduodenal mucosa from irritating effects of hydrochloric acid, pepsin, and the detergent effect of bile during reflux by means of formation of a strong mucoadhesive biofilm on the walls of the esophagus. The authors present the results of a randomized, double‑blind, controlled clinical trial evaluating the efficacy and safety of a preparation based on alginate/sodium bicarbonate in combination with extracts obtained from Opuntia ficus indica and Olea europaea related to polyphenols on the dynamics of GERD symptoms. It has been established that Gastrotop is well tolerated and effective in controlling symptoms associated with mild GERD manifestations. The results demonstrated the perspective of administration of a standardized complex of polysaccharides as part of Gastrotop in cases when it’s necessary to cancel antisecretory drugs (in particular, proton pump inhibitors PPIs), for example, before assessing the persistence of Helicobacter pylori infection or for the purpose of monitoring of the eradication effectiveness. The use of cytoprotectors in GERD promotes the reduction of incidence and prevention of possible complications, caused by the long‑term PPIs’ use.
