Gastroesophageal Reflux Disease (GERD) is characterized by acid and bile reflux in the distal
oesophagus, and this may cause the development of reflux esophagitis and Barrett’s oesophagus
(BE). The natural histological course of untreated BE is non-dysplastic or benign BE (ND), then lowgrade
(LGD) and High-Grade Dysplastic (HGD) BE, with the expected increase in malignancy transfer
to oesophagal adenocarcinoma (EAC). The gold standard for BE diagnostics involves high-resolution
white-light endoscopy, followed by uniform endoscopy findings description (Prague classification)
with biopsy performance according to Seattle protocol. The medical treatment of GERD and BE
includes the use of proton pump inhibitors (PPIs) regarding symptoms control. It is noteworthy that
long-term use of PPIs increases gastrin level, which can contribute to transfer from BE to EAC, as a
result of its effects on the proliferation of BE epithelium. Endoscopy treatment includes a wide range
of resection and ablative techniques, such as radio-frequency ablation (RFA), often concomitantly used
in everyday endoscopy practice (multimodal therapy). RFA promotes mucosal necrosis of treated
oesophagal region via high-frequency energy. Laparoscopic surgery, partial or total fundoplication, is
reserved for PPIs and endoscopy indolent patients or in those with progressive disease. This review
aims to explain distinct effects of PPIs and RFA modalities, illuminate certain aspects of molecular
mechanisms involved, as well as the effects of their concomitant use regarding the treatment of BE and
prevention of its transfer to EAC.
Accelerating Development of Benziamidazole-Class Proton Pump Inhibitors: A Mechanism-Based PK/PD Model to Optimize Study Design with Ilaprazole as a Case Drug
