Mucosal Protective Compounds in the Treatment of Gastroesophageal Reflux Disease. A Position Paper Based on Evidence of the Romanian Society of Neurogastroenterology

2016 ◽  
Vol 25 (4) ◽  
pp. 537-546 ◽  
Author(s):  
Teodora Surdea-Blaga ◽  
Ion Băncilă ◽  
Daniela Dobru ◽  
Vasile Drug ◽  
Ovidiu Frățilă ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Reflux Disease ◽  
Position Paper ◽  
Esophageal Mucosa ◽  
Reflux Symptoms

Background & Aims: Gastroesophageal reflux disease (GERD) therapy is challenging and suppression of acid secretion or prokinetics do not cure all cases. Some drugs with protective action on the esophageal mucosa have been used alternatively or in association with proton pump inhibitors (PPIs) and/or prokinetics. The Romanian Society of Neurogastroenterology undertook an Evidence-Based analysis, from which this position paper evolved. Methods: We performed a systematic literature search in PubMed until October 2015, using the terms: sucralfate, guaiazulene, gaiazulene, dimethicone, alginate, antacids and gastroesophageal reflux. Forty-seven papers were included and analyzed. Several statements were elaborated regarding the use of these drugs in GERD. The evidence and recommendations were discussed between the authors. Results: There is evidence in the medical literature suggesting the benefit of these drugs in GERD. In patients with persistent or mild reflux symptoms antacids rapidly relieve heartburn. Alginate-antacid combination is superior both over placebo and antacids to treat mild reflux symptoms, and can be used to treat persistent reflux symptoms despite acid suppressant therapy. Sucralfate is superior over placebo in alleviating GERD symptoms and can be used as maintenance therapy. Guaiazulene-dimethicone improves the quality of life in patients with GERD. Conclusions: Drugs used to protect the esophageal mucosa against acid are useful in alleviating chronic heartburn, especially in patients with mild reflux symptoms. Abbreviations: CS: Chondroitin sulfate; DA: Double Action; EE : Erosive esophagitis ; GERD: Gastroesophageal reflux disease; HA: Hyaluronic acid; H2RA: Histamine 2 receptor antagonist; ITT: Intention to treat; IM: Irsogladine maleate; NERD: Non-erosive reflux disease; PPIs: Proton pump inhibitors; RCT: Randomized controlled trial; RDQ: Reflux disease questionnaire; QoL: Quality of life.

scholarly journals Refractory gastroesophageal reflux disease

2012 ◽  
Vol 49 (4) ◽  
pp. 296-301 ◽  
Author(s):  
Joaquim Prado P. Moraes-Filho
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Reflux Disease ◽  
Skin Diseases ◽  
Pharmacological Therapy ◽  
Genotypic Differences ◽  
Esophageal Mucosa ◽  
Refractory Gerd

CONTEXT: Gastroesophageal reflux disease (GERD) is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Its pathophysiology, diagnosis and treatment have frequently been analyzed but it is interesting to review some aspects of the GERD refractory patients to the proton pump inhibitors treatment. The treatment encompasses behavioral measures and pharmacological therapy. The majority of the patients respond well to proton pump inhibitors treatment but 20%-42% of them may not do so well. Patients who are unresponsible to 4-8 weeks' treatment with proton pump inhibitors (omeprazole, pantoprazole, rabeprazole, lansoprazole, esomeprazole, pantoprazole-Mg) might have so-called refractory GERD. RESULTS: In some cases the patients are not real refractory because either they do not have GERD or the disease was not correctly treated, but the term refractory is still employed. Although debatable, the Brazilian GERD Consensus based upon evidences recommends as first step in the diagnosis, the upper digestive endoscopy to exclude the diagnosis of peptic ulcer and cancer and in some cases identify the presence of esophageal mucosa erosions. CONCLUSIONS: The main causes of the so-called refractory GERD are: (1) functional heartburn; (2) low levels of adherence to proton pump inhibitors treatment; (3) inadequate proton pump inhibitors dosage; (4) wrong diagnosis; (5) co-morbidities and pill-induced esophagitis; (6) genotypic differences; (7) nonacid gastroesophageal reflux; (8) autoimmune skin diseases; (9) eosinophilic esophagitis.

scholarly journals Extraesophageal signs of gastroesophageal reflux disease: otorhinolaryngologist’s view

2021 ◽  
Vol 93 (4) ◽  
pp. 521-525
Author(s):  
Elena Yu. Radtsig ◽  
Daniil I. Konstantinov
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Reflux Disease ◽  
Chondroitin Sulphate ◽  
Clinical Manifestations ◽  
Esophageal Mucosa ◽  
Allergenic Potential ◽  
Repairing Effect

The data on association between various pathologies of the ENT organs and gastroesophageal reflux disease (GERD) is analysed in the article. The variety of extraesophageal signs of GERD in children and adults is given, what is advisable to inform physicians of different specialties about the possibilities of antireflux therapy. These options are expanded with the emergence of a unique new drug, Alfasoxx. Its bioadhesive formula is based on hyaluronic acid and chondroitin sulphate thereby protecting the esophageal mucosa. Alfasoxx acts on the surface of the esophageal mucosa without penetrating into the systemic bloodstream and it also has a low allergenic potential, which has been confirmed by numerous studies. With its healing and repairing effect on erosive lesions of the esophageal epithelium, Alfasoxx in combination with proton pump inhibitors is more effective in achieving regression of clinical manifestations of the disease and improving patients quality of life (according to SF-36 questionnaire) compared to proton pump inhibitors monotherapy.

scholarly journals Penyakit Refluks Gastroesofageal Berat (PRGE) pada Anak dengan Riwayat Gizi Buruk dan Kelahiran Prematur

2021 ◽  
Vol 36 (2) ◽  
pp. 63-70
Author(s):  
Pramita G.D. Poerwantoro ◽  
Yuni Astria
Keyword(s):  
Quality Of Life ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Premature Birth ◽  
Feeding Tube ◽  
Z Score

Abstrak Penyakit refluks gastroesofageal berat (PRGE)adalah gerakan retrograd isi lambung ke kerongkongan. Pada prematuritas, kelemahan peristaltik esofagus terjadi akibat kurangnya relaksasi reseptif bersihan material refluks ke esofagus. Penyakit ini menyebabkan penurunan kualitas hidup dan komplikasi. Laporan ini bertujuan menggambarkan kasus PRGE parah pada anak marasmik dengan kelahiran prematur. Kasus berasal dari seorang anak perempuan berusia tiga tahun dirawat di Rumah Sakit Umum Cipto Mangunkusumo karena menderita muntah terus-menerus setiap kali setelah menyusu. Pasien lahir prematur pada usia kehamilan 31 minggu dengan berat lahir 900 gram, mengalami malnutrisi berat dan keterlambatan perkembangan. Pasien menjalani prosedur endoskopi, pemeriksaan histopatologi dan didapatkan esofagitis berat, gastritis erosif, striktur pilorik, dan refluks laringofaringeal (LPR).Pasien diberikan proton pump inhibitors (PPIs), menjalani dilatasi pilorik satu kali dan pemasangan nasogastricjejunal feeding tube (NJFT), serta susu formula khusus medium chain tryglyceride (MCT) enam kali sehari. Dalam 18 bulan masa tindak lanjut, pasien menunjukkan peningkatan skor Z berat-berdasarkan-panjang badan, panjang berdasarkan usia dan lingkar kepala berdasarkan usia.Dalam menangani bayi prematur, harus mempertimbangkan PRGE sebagai salah satu etiologi pertumbuhan yang terganggu. Prosedur endoskopi dan pemasangan NJFT untuk terapi nutrisi jangka panjang mengurangi komplikasi dan meningkatkan kualitas hidup.Follow up intensif diperlukan agar mencapai pertumbuhan dan perkembangan optimal.   Kata kunci: anak, komplikasi, GERD, lahir prematur, proton pump inhibitors Severe Gastroesophageal Reflux Disease in Malnourished Children with History of Prematurity Abstract Gastroesophageal reflux disease (GERD) is an involuntary retrograde propulsion of gastric contents to esophagus. In prematurity, esophagus peristaltic weakness due to lack of receptive relaxation contribute to inadequate cleaning of material reflux to esophagus which become GERD predisposition. Furthermore, GERD can cause a decline of quality of life and various complications. This report aimed to describe severe GERD case in a marasmic child with premature birth. A 36-month-old girl was hospitalized at dr. Cipto Mangunkusumo General Hospital because of persistent vomitus after every milk feeding. She was prematurely born at 31 weeks of gestation with birthweight of 900 grams, and become severely malnourished with developmental delayed. She then underwent gastrointestinal endoscopic procedure and histopathology examination that revealed a severe esophagitis, erosive gastritis, pyloric stricture, and laryngopharyngeal reflux (LPR).She was treated with proton pump inhibitors (PPI) and underwent one-time pyloric dilatation with nasogastricjejunal feeding tube (NJFT) insertion and continued with medium chain triglycerides formula six times a day. At 18-month follow-up, weight-for-length Z score, length-for-age and head circumference Z score are increased.In dealing with premature baby, we should consider GERD as one of growth faltering etiologies. Endoscopy procedure followed by NJFT insertion for long-term nutrition therapy in severe GERD are the cornerstones to reduce complications and to improve quality of life. Moreover, close follow up for optimal growth and development should be done in such case. Keywords: children, complications, GERD, premature birth, proton pump inhibitors

scholarly journals Association of hepatobiliary pathology and gastroesophageal reflux disease

2021 ◽  
Vol 5 (6) ◽  
pp. 404-412
Author(s):  
A.N. Kazyulin ◽  
◽  
A.Yu. Goncharenko ◽  
I.E. Kalyagin ◽  
◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Ursodeoxycholic Acid ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Reflux Disease ◽  
Digestive System ◽  
Biliary Dyskinesia ◽  
Esophageal Mucosa ◽  
Duodenogastroesophageal Reflux

The problem of comorbidity with a high risk of polypragmasia is relevant in a large group of patients with diseases in the digestive system. Currently, the problem of comorbidity in patients with gastroesophageal reflux disease (GERD) attracts the attention of specialists due to the high disease prevalence and data indicating its association with other digestive system diseases, primarily of the hepatobiliary system. The article presents the results of clinical and experimental studies revealing the pathogenetic connections of GERD and hepatobiliary pathology accompanied by biliary dyskinesia, factors leading to an impairment of the duodenal propulsive activity. It is noted that the most important components of the esophageal mucosa lesion in duodenogastroesophageal reflux are bile acids, lysolecithin and pancreatic enzymes. The relevance of prescribing drugs that can affect the course of pathogenetically related diseases, which can significantly reduce the risk of polypragmasia, is justified. Such drugs include ursodeoxycholic acid, which, in the conditions of the GERD and hepatobiliary pathology association, contributes to the functional state normalization of the liver and biliary tract, reduces biliary dyskinesia, the severity of duodenal hypertension and duodenogastroesophageal reflux. The next example is the rebamipide cytoprotector, which has a multilateral protective effect against the mucous membrane of the GIT, including the esophagus, gastroduodenal zone, small intestine, as well as liver. The expediency of prescribing rebamipide to patients who are refractory to therapy with proton pump inhibitors is justified. KEYWORDS: comorbidity, hepatobiliary pathology, gastroesophageal reflux disease, ursodeoxycholic acid, rebamipid, proton pump inhibitors. FOR CITATION: Kazyulin A.N., Goncharenko A.Yu., Kalyagin I.E. Association of hepatobiliary pathology and gastroesophageal reflux disease. Russian Medical Inquiry. 2021;5(6):404–412 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-404-412.

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