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Optimal acid suppressive treatment for adequate symptom relief and prevention of the complications of gastroesophageal reflux disease: differences in long-term clinical course and pathophysiology among disease subtypes

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Abstract

Gastroesophageal reflux disease (GERD) is a chronic long-standing disease. Most patients with GERD are thought to require long-term treatment with acid suppressants, with proton pump inhibitors being the drugs of choice in managing these patients. However, there has been no consensus about the frequency of spontaneous remission of GERD. Furthermore, the duration of treatment is individually based, and the end-point of treatment is also not clear. As the symptoms of GERD may be intermittent or occur on most days of the week, treatment may be short term, lasting 8–12 weeks, or long term, lasting more than 1 year. Moreover, treatment may be continuous, intermittent, or on-demand. In contrast, maintenance therapy consists of the lowest proton pump inhibitor dose necessary for adequate symptom relief and prevention of GERD-related complications. GERD has been classified into three subgroups based on endoscopic severity: non-erosive reflux disease (NERD), mild erosive esophagitis (EE), and severe EE. Because these three subgroups differ in long-term clinical course and pathophysiology, their treatment strategies should differ. Treatment of severe EE should include two clinical goals: relief of GERD symptoms and prevention of EE-related complications, such as esophageal ulcer bleeding and/or strictures. However, because mild EE, including NERD, rarely progresses to severe EE during symptom-driven treatment, treatment of these patients should have one clinical goal: relief of GERD symptoms.

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Authors and Affiliations

  1. Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan

    Noriaki Manabe

  2. Department of General Internal Medicine 2, Kawasaki Medical School Kawasaki Hospital, Okayama, Japan

    Ken Haruma

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  1. Noriaki Manabe
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  2. Ken Haruma
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Correspondence to Noriaki Manabe.

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Ethical Statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent was obtained from all patients included in the cited studies.

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Identifying information on human subjects, including names, initials, addresses, admission dates, hospital numbers, or any other data that might identify patients were not published in written descriptions, photographs, or pedigrees unless the information is essential for scientific purposes and the patient (or parent guardian) gives written informed consent for publication.

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Manabe, N., Haruma, K. Optimal acid suppressive treatment for adequate symptom relief and prevention of the complications of gastroesophageal reflux disease: differences in long-term clinical course and pathophysiology among disease subtypes. Esophagus 14, 113–121 (2017). https://doi.org/10.1007/s10388-016-0558-0

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