Proton Pump Inhibitors in Gastroesophageal Reflux Disease: Friend or Foe
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Purpose of Review
Proton pump inhibitor (PPI) use in gastroesophageal reflux disease (GERD) has been redefined, in light of recent advances highlighting GERD phenotypes that respond to PPIs, and fresh revelations of potential risks of long-term PPI therapy.
Erosive esophagitis predicts excellent response to PPI therapy, but non-erosive reflux disease (NERD) with abnormal reflux parameters on ambulatory reflux monitoring also demonstrates a similar response. In contrast, response is suboptimal in the absence of abnormal reflux parameters. In this setting, if an alternate appropriate indication for PPI therapy does not coexist, risks may outweigh benefits of PPI therapy. Adverse events from long-term PPI therapy continue to be reported, most based on association rather than cause-and-effect.
Appropriate indications need to be established before embarking on long-term PPI therapy. Future research will define true risks of long-term PPI therapy, and develop alternate management options for acid peptic diseases.
KeywordsGastroesophageal reflux disease Proton pump inhibitors: heartburn Endoscopy Ambulatory reflux monitoring Esophageal manometry
Compliance with Ethical Standards
Conflict of Interest
Prakash Gyawali reports grants and personal fees from Medtronic, Inc. and personal fees from Torax, Quintiles, Ironwood, and Allergan for consulting and speaking, outside the submitted work.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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