Alternative therapeutic approaches to chronic proton pump inhibitor treatment.

Chronic consumption of proton pump inhibitors (PPIs) by patients with gastroesophageal reflux disease is very common, primarily because of their potent and profound effect on acid secretion that results in an unsurpassed rate of symptom resolution and esophageal healing. However, there have been a growing number of reports over the past few years about various side effects caused by chronic PPI treatment. Concerns have been raised by patients and physicians alike about the common practice of prescribing PPIs, often more than once daily, on a long-term basis.

Pharmacological management of GERD: where does it stand now?

Gastroesophageal reflux disease (GERD) is very common and advances in drug development over recent years have markedly improved GERD management. A wide range of medications are currently used in GERD treatment, including antacids, Gaviscon, sucralfate, histamine-2 receptor antagonists and prokinetics. However, proton pump inhibitors (PPIs) remain the mainstay of treatment for GERD owing to their profound and consistent inhibitory effect on acid secretion.

The effect of antireflux treatment on patients with gastroesophageal reflux disease undergoing a mental arithmetic stressor.

Background: Acute stress exacerbates heartburn in gastroesophageal reflux disease (GERD) patients by enhancing the perceptual responses to intraesophageal acid. The aim of the study was to determine if antireflux treatment can still alter stimulus response functions to acid in patients undergoing acute stress as compared with placebo.

Methods: Symptomatic GERD patients with erosive esophagitis (EE) or an abnormal pH test were included.

Night-time intra-oesophageal bile and acid: a comparison between gastro-oesophageal reflux disease patients who failed and those who were treated successfully with a proton pump inhibitor.

Background: Little is known about the contribution of bile and acid reflux to night-time symptoms generation in patients who failed PPI treatment.

Aim: To compare the degree of night-time oesophageal acid and bile [by the surrogate duodenogastroesophageal reflux (DGER)] exposure between gastro-oesophageal reflux disease (GERD) patients who failed and those who fully responded to PPI once a day while on treatment.

Methods: Gastro-oesophageal reflux disease patients were assigned to the PPI failure group if they continued to report symptoms ≥3/week and to the PPI success group if they were asymptomatic for the last 3 months while on PPI once a day.

Upper GI tract findings in patients with heartburn in whom proton pump inhibitor treatment failed versus those not receiving antireflux treatment.

Background: Failure of proton pump inhibitor (PPI) treatment in patients with heartburn is very common. Because endoscopy is easily accessible, it is commonly used as the first evaluative tool in these patients.

Objective: To compare GERD-related endoscopic and histologic findings in patients with heartburn in whom once-daily PPI therapy failed versus those not receiving antireflux treatment.

The effect of esomeprazole 20 mg twice daily on acoustic and perception parameters of the voice in laryngopharyngeal reflux.

Background: Randomized, placebo-controlled studies have failed to demonstrate a significant treatment effect for laryngopharyngeal reflux (LPR) using traditional clinical endpoints. We compared the effect of esomeprazole 20 mg twice daily (b.i.

Comparison of the degree of duodenogastroesophageal reflux and acid reflux between patients who failed to respond and those who were successfully treated with a proton pump inhibitor once daily.

Objectives: The objective of this study was to compare the degree of esophageal acid exposure and duodenogastroesophageal reflux (DGER) during treatment between gastroesophageal reflux disease (GERD) patients who responded fully to proton pump inhibitor (PPI) once a day and those who failed to respond.

Methods: Gastroesophageal reflux disease patients who continued to report symptoms 3 times a week for 3 months while on PPI once a day were assigned to the PPI failure group. GERD patients who were asymptomatic on PPI once a day for 3 months were assigned to the PPI success group.

Functional heartburn: what it is and how to treat it.

Functional heartburn is considered one of the most common functional esophageal disorders. The disorder is more common in young women and is associated with other functional bowel disorders and psychological co-morbidity, primarily somatization. The etiology of functional heartburn remains unknown.

Review article: gastro-oesophageal reflux disease and psychological comorbidity.

Background: A growing number of studies have shown the impact of psychological comorbidities on gastro-oesophageal reflux disease (GERD) patients' symptom reports and healthcare-seeking behaviour.

Aim: To review the reported relationship between GERD and psychological comorbidity.

Methods: Review of the literature on GERD and psychological comorbidity.

Clinical trial: the effect of Johrei on symptoms of patients with functional chest pain.

Background: Patients with functional chest pain (FCP) represent a therapeutic challenge for practising physicians.

Aim: To determine the efficacy of Johrei as compared to wait-list in improving symptoms of FCP patients.

Methods: Patients with chest pain of noncardiac origin for at least 3 months were enrolled into the study.

Non-erosive reflux disease (NERD) and erosive esophagitis--a spectrum of disease or special entities?

An understanding of the natural history of GERD has an important impact on the long-term management of the disorder. By assessing the currently available studies that evaluated the natural course of GERD, a new conceptual framework that suggests that GERD is composed of three distinct phenotypic presentations has been recently proposed. Presently, the field has been divided into two camps that support or oppose a paradigm shift in the natural course of GERD.

Clinical trial: acupuncture vs. doubling the proton pump inhibitor dose in refractory heartburn.

Background: The current standard of care in proton pump inhibitor failure is to double the proton pump inhibitor dose, despite limited therapeutic gain. Aims To determine the efficacy of adding acupuncture vs. doubling the proton pump inhibitor dose in gastro-oesophageal reflux disease patients who failed symptomatically on proton pump inhibitors once daily.

Comparisons of the distribution of oesophageal acid exposure throughout the sleep period among the different gastro-oesophageal reflux disease groups.

Background: Nocturnal gastro-oesophageal reflux diseases (GERD) can lead to oesophageal mucosal injury and extra-oesophageal complications.

Aim: To compare distribution of oesophageal acid exposure during sleep time among patients with non-erosive reflux disease and abnormal pH test (NERD-positive), erosive oesophagitis (EO) and Barrett's oesophagus (BO).

Methods: Patients underwent endoscopy followed by 24-h oesophageal pH testing.

Symptom assessment tools for gastroesophageal reflux disease (GERD) treatment.

Relief of symptoms, both typical and atypical, is the mainstay of therapy for patients with gastroesophageal reflux disease (GERD); however, evaluation of GERD symptoms' response to treatment has been hampered by the lack of a questionnaire that meets all the criteria of an ideal evaluative GERD symptom assessment tool. These criteria are: sensitivity in GERD patients, covering all symptom dimensions (multidimensional construct), assessment of frequency and intensity of "typical" and "atypical" GERD symptoms, practical and economical, easy to understand, responsive over short time intervals, use as a patient self-assessment tool, amenable to daily use, psychometrically validated, and translation into many languages with cross-cultural adaptation. Thus far, 14 instruments have been developed to assess GERD symptoms and potentially can be used to evaluate treatment response during a therapeutic trial in GERD patients.

Prevalence of upper gastrointestinal tract findings in patients with noncardiac chest pain versus those with gastroesophageal reflux disease (GERD)-related symptoms: results from a national endoscopic database.

Background: Available data on the prevalence of esophageal and upper gut findings in patients with noncardiac chest pain (NCCP) are scarce and limited to one center's experience.

Aim: To determine the prevalence of esophageal and upper gut mucosal findings in patients undergoing upper endoscopy for NCCP only versus those with gastroesophageal reflux disease (GERD) symptoms only, using the national Clinical Outcomes Research Initiative (CORI) database.

Methods: During the study period, the CORI database received endoscopic reports from a network of 76 community, university, and Veteran Administration Health Care System (VAHCS)/military practice sites.

Erosive esophagitis and nonerosive reflux disease (NERD): comparison of epidemiologic, physiologic, and therapeutic characteristics.

Nonerosive reflux disease (NERD) and erosive esophagitis are the main presentations of gastroesophageal reflux disease. However, NERD is the most common presentation of gastroesophageal reflux disease in community-based patients. Patients with NERD differ in demographic characteristics from patients with erosive esophagitis, primarily in sex distribution, weight/body mass index, and prevalence of hiatal hernia.

Chest pain of esophageal origin.

Chest pain of esophageal origin is the most common atypical/extraesophageal manifestation of gastroesophageal reflux disease (GERD). We are increasingly recognizing the important role of the cardiologist in making the diagnosis. Studies continue to focus on the mechanisms of pain in this challenging group of patients.

Chest pain of esophageal origin.

Chest pain of esophageal origin or noncardiac chest pain is reported by at least a fifth of the general population. Recent literature focused on further understanding mechanisms of chest pain in subset of patients with functional chest pain of presumed esophageal origin. Studies have demonstrated concurrent visceral and somatic pain hypersensitivity, and amplified secondary allodynia, in patients with noncardiac chest pain (NCCP), suggesting central sensitization.

Functional heartburn patients demonstrate traits of functional bowel disorder but lack a uniform increase of chemoreceptor sensitivity to acid.

Background: Functional heartburn (FH) patients have a profound impact on the response to anti-reflux therapy of the nonerosive reflux disease (NERD) group as compared to the response of the erosive esophagitis group. Thus far, there is paucity of information about their physiological and clinical characteristics that may separate them from the other NERD patients.

Aim: To compare physiological and clinical characteristics of patients with FH to their counterparts within the NERD group (NERD-positive [NERD+]).

Treatment of patients with persistent heartburn symptoms: a double-blind, randomized trial.

Background & Aims: Common treatment practices in patients who continue to be symptomatic on proton pump inhibitor once-daily treatment include either increasing the dosage or the use of supplemental medication. This trial's purpose was to compare 2 therapeutic strategies, increasing the proton pump inhibitor dosage to twice daily versus switching to another proton pump inhibitor, in patients with persistent heartburn while receiving standard-dose proton pump inhibitor therapy.

Methods: This multicenter, randomized, double-blind, double-dummy trial included patients with persistent heartburn symptoms while receiving therapy with lansoprazole 30 mg once daily.