The management of proton pump inhibitor-refractory gastroesophageal reflux disease (GERD) is a challenge in clinical practice.
Since up to one-third of patients with typical GERD symptoms are not satisfied with proton pump inhibitor (PPI) therapy, new drug development targeting different pathophysiologies of GERD is imperative.
Dr Yu-Min Kung and colleagues from Taiwan review recent advance in the pharmacological management of GERD.
|Visceral hypersensitivity also contributes to the perception of GERD symptoms|
|Digestive Diseases & Sciences|
At present, no other drugs serve as a more potent acid suppression agent than PPIs.
As an add-on therapy, histamine type-2 receptor antagonists, alginates, prokinetics and transient lower esophageal sphincter relaxation inhibitors have some impact on the subgroups of rGERD, but greater effectiveness and fewer adverse effects for widespread use are required.
Visceral hypersensitivity also contributes to the perception of GERD symptoms, and neuromodulators including antidepressants play a role in this category.
Dr Kung's team concludes, "Esophageal pH-impedance monitoring helps to distinguish functional heartburn from true GERD, and psychologic medication and cognitive behavior therapy are further therapy options instead of PPIs."