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Medical Management of GERD

  • Feng Li
  • Stephanie Denise Pointer
  • Jon P. WalkerEmail author
Chapter

Abstract

Nonsurgical approaches continue to be at the cornerstone for initial therapy of GERD. Ultimately, the most efficacious therapy depends on the etiology of GERD symptoms. Therapies range from acid suppression with proton pump inhibitors to baclofen for non-acid reflux to neuromodulators for functional heartburn. While PPI therapy is very safe, it is important to understand the reported potential pitfalls of long-term use. The prescriber must also understand the risks and benefits of GERD therapy in the pregnant or breastfeeding patient. This chapter presents an overview of the therapeutic options available to the managing provider.

Keywords

Proton pump inhibitor H2 blocker GERD Non-acid reflux Functional heartburn 

References

  1. 1.
    Nwokediuko SC. Current trends in the management of gastroesophageal reflux disease: a review. ISRN Gastroenterol. 2012;2012:391631.CrossRefGoogle Scholar
  2. 2.
    Jacobson BC, et al. Body-mass index and symptoms of gastroesophageal reflux in women. N Engl J Med. 2006;354(22):2340–8.CrossRefGoogle Scholar
  3. 3.
    Fraser-Moodie CA, et al. Weight loss has an independent beneficial effect on symptoms of gastro-oesophageal reflux in patients who are overweight. Scand J Gastroenterol. 1999;34(4):337–40.CrossRefGoogle Scholar
  4. 4.
    Mathus-Vliegen LM, Tytgat GN. Twenty-four-hour pH measurements in morbid obesity: effects of massive overweight, weight loss and gastric distension. Eur J Gastroenterol Hepatol. 1996;8(7):635–40.PubMedGoogle Scholar
  5. 5.
    Nam SY. Obesity-related digestive diseases and their pathophysiology. Gut Liver. 2016;11:323.CrossRefGoogle Scholar
  6. 6.
    El-Serag HB, et al. Obesity is an independent risk factor for GERD symptoms and erosive esophagitis. Am J Gastroenterol. 2005;100(6):1243–50.CrossRefGoogle Scholar
  7. 7.
    Nocon M, et al. Association of body mass index with heartburn, regurgitation and esophagitis: results of the Progression of Gastroesophageal Reflux Disease study. J Gastroenterol Hepatol. 2007;22(11):1728–31.CrossRefGoogle Scholar
  8. 8.
    Harvey RF, et al. Effects of sleeping with the bed-head raised and of ranitidine in patients with severe peptic oesophagitis. Lancet. 1987;2(8569):1200–3.CrossRefGoogle Scholar
  9. 9.
    Duroux P, et al. Early dinner reduces nocturnal gastric acidity. Gut. 1989;30(8):1063–7.CrossRefGoogle Scholar
  10. 10.
    Orr WC, Harnish MJ. Sleep-related gastro-oesophageal reflux: provocation with a late evening meal and treatment with acid suppression. Aliment Pharmacol Ther. 1998;12(10):1033–8.CrossRefGoogle Scholar
  11. 11.
    Kohata Y, et al. Long-term benefits of smoking cessation on gastroesophageal reflux disease and health-related quality of life. PLoS One. 2016;11(2):e0147860.CrossRefGoogle Scholar
  12. 12.
    Hunt RH. Importance of pH control in the management of GERD. Arch Intern Med. 1999;159(7):649–57.CrossRefGoogle Scholar
  13. 13.
    Inadomi JM, et al. Step-down management of gastroesophageal reflux disease. Gastroenterology. 2001;121(5):1095–100.CrossRefGoogle Scholar
  14. 14.
    Inadomi JM, et al. Step-down from multiple-to single-dose proton pump inhibitors (PPIs): a prospective study of patients with heartburn or acid regurgitation completely relieved with PPIs. Am J Gastroenterol. 2003;98(9):1940–4.CrossRefGoogle Scholar
  15. 15.
    Weberg R, Berstad A. Symptomatic effect of a low-dose antacid regimen in reflux oesophagitis. Scand J Gastroenterol. 1989;24(4):401–6.CrossRefGoogle Scholar
  16. 16.
    Richter JE. Review article: the management of heartburn in pregnancy. Aliment Pharmacol Ther. 2005;22(9):749–57.CrossRefGoogle Scholar
  17. 17.
    Wang YK, et al. Current pharmacological management of gastroesophageal reflux disease. Gastroenterol Res Pract. 2013;2013:983653.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Simon B, Ravelli GP, Goffin H. Sucralfate gel versus placebo in patients with non-erosive gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 1996;10(3):441–6.CrossRefGoogle Scholar
  19. 19.
    Simon B, Mueller P. Comparison of the effect of sucralfate and ranitidine in reflux esophagitis. Am J Med. 1987;83(3b):43–7.CrossRefGoogle Scholar
  20. 20.
    Wolfe MM, Sachs G. Acid suppression: optimizing therapy for gastroduodenal ulcer healing, gastroesophageal reflux disease, and stress-related erosive syndrome. Gastroenterology. 2000;118(2 Suppl 1):S9–31.CrossRefGoogle Scholar
  21. 21.
    Robinson M, et al. A comparison of lansoprazole and ranitidine in the treatment of erosive oesophagitis. Aliment Pharmacol Ther. 1995;9(1):25–31.CrossRefGoogle Scholar
  22. 22.
    Vantrappen G, et al. Omeprazole (40 mg) is superior to ranitidine in short-term treatment of ulcerative reflux esophagitis. Dig Dis Sci. 1988;33(5):523–9.CrossRefGoogle Scholar
  23. 23.
    Sigterman KE, et al. Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease. Cochrane Database Syst Rev. 2013;(5):1–84.Google Scholar
  24. 24.
    Labenz J, Malfertheiner P. Treatment of uncomplicated reflux disease. World J Gastroenterol. 2005;11(28):4291–9.CrossRefGoogle Scholar
  25. 25.
    Chiba N, et al. Speed of healing and symptom relief in grade II to IV gastroesophageal reflux disease: a meta-analysis. Gastroenterology. 1997;112(6):1798–810.CrossRefGoogle Scholar
  26. 26.
    Gralnek IM, et al. Esomeprazole versus other proton pump inhibitors in erosive esophagitis: a meta-analysis of randomized clinical trials. Clin Gastroenterol Hepatol. 2006;4(12):1452–8.CrossRefGoogle Scholar
  27. 27.
    Dickman R, et al. Comparison of clinical characteristics of patients with gastroesophageal reflux disease who failed proton pump inhibitor therapy versus those who fully responded. J Neurogastroenterol Motil. 2011;17:387.CrossRefGoogle Scholar
  28. 28.
    Pace F, et al. Systematic review: maintenance treatment of gastro-oesophageal reflux disease with proton pump inhibitors taken ‘on-demand’. Aliment Pharmacol Ther. 2007;26(2):195–204.CrossRefGoogle Scholar
  29. 29.
    Sheen E, Triadafilopoulos G. Adverse effects of long-term proton pump inhibitor therapy. Dig Dis Sci. 2011;56(4):931–50.CrossRefGoogle Scholar
  30. 30.
    Lodato F, et al. Adverse effects of proton pump inhibitors. Best Pract Res Clin Gastroenterol. 2010;24(2):193–201.CrossRefGoogle Scholar
  31. 31.
    Hoorn EJ, et al. A case series of proton pump inhibitor-induced hypomagnesemia. Am J Kidney Dis. 2010;56(1):112–6.CrossRefGoogle Scholar
  32. 32.
    FDA Drug Safety Communication: Low magnesium levels can be associated with long-term use of proton pump inhibitor drugs (PPIs). 2011 [cited 2016 November 29]; Available from: http://www.fda.gov/safety/medwatch/safetyinformation/ucm258810.htm.
  33. 33.
    Fraser LA, et al. The effect of proton pump inhibitors on fracture risk: report from the Canadian Multicenter Osteoporosis Study. Osteoporos Int. 2013;24(4):1161–8.CrossRefGoogle Scholar
  34. 34.
    Bavishi C, Dupont H. Systematic review: the use of proton pump inhibitors and increased susceptibility to enteric infection. Aliment Pharmacol Ther. 2011;34(11–12):1269–81.CrossRefGoogle Scholar
  35. 35.
    Eom C-S, et al. Use of acid-suppressive drugs and risk of pneumonia: a systematic review and meta-analysis. Can Med Assoc J. 2011;183(3):310–9.CrossRefGoogle Scholar
  36. 36.
    Johnstone J, Nerenberg K, Loeb M. Meta-analysis: proton pump inhibitor use and the risk of community-acquired pneumonia. Aliment Pharmacol Ther. 2010;31(11):1165–77.CrossRefGoogle Scholar
  37. 37.
    Giuliano C, Wilhelm SM, Kale-Pradhan PB. Are proton pump inhibitors associated with the development of community-acquired pneumonia? A meta-analysis. Expert Rev Clin Pharmacol. 2012;5(3):337–44.CrossRefGoogle Scholar
  38. 38.
    Hermos JA, et al. Risk of community-acquired pneumonia in veteran patients to whom proton pump inhibitors were dispensed. Clin Infect Dis. 2011;54(1):33–42.Google Scholar
  39. 39.
    Sibbing D, et al. Impact of proton pump inhibitors on the antiplatelet effects of clopidogrel. Thromb Haemost. 2009;101(4):714–9.CrossRefGoogle Scholar
  40. 40.
    Gerson LB, et al. Lack of significant interactions between clopidogrel and proton pump inhibitor therapy: meta-analysis of existing literature. Dig Dis Sci. 2012;57(5):1304–13.CrossRefGoogle Scholar
  41. 41.
    Lazarus B, et al. Proton pump inhibitor use and the risk of chronic kidney disease. JAMA Intern Med. 2016;176(2):238–46.CrossRefGoogle Scholar
  42. 42.
    Gomm W, et al. Association of proton pump inhibitors with risk of dementia: a pharmacoepidemiological claims data analysis. JAMA Neurol. 2016;73(4):410–6.CrossRefGoogle Scholar
  43. 43.
    Badiola N, et al. The proton-pump inhibitor lansoprazole enhances amyloid beta production. PLoS One. 2013;8(3):e58837.CrossRefGoogle Scholar
  44. 44.
    Champion M. Prokinetic therapy in gastroesophageal reflux disease. Can J Gastroenterol = J can gastroenterol. 1997;11:55B–65B.Google Scholar
  45. 45.
    Richter JE, et al. Omeprazole versus ranitidine or ranitidine/metoclopramide in poorly responsive symptomatic gastroesophageal reflux disease. Am J Gastroenterol. 1996;91(9):1766–72.Google Scholar
  46. 46.
    Rao A, Camilleri M. Review article: metoclopramide and tardive dyskinesia. Aliment Pharmacol Ther. 2010;31(1):11–9.CrossRefGoogle Scholar
  47. 47.
    Reglan (metoclopramide) tablets, ODT (Orally Disintegrating Tablets), and injection. 2009 [cited 2016 November 29]; Available from: http://www.fda.gov/Safety/MedWatch/SafetyInformation/ucm170934.htm.
  48. 48.
    Maddern G, et al. Domperidone, metoclopramide, and placebo: all give symptomatic improvement in gastroesophageal reflux. J Clin Gastroenterol. 1986;8(2):135–40.CrossRefGoogle Scholar
  49. 49.
    van Noord C, et al. Domperidone and ventricular arrhythmia or sudden cardiac death. Drug Saf. 2010;33(11):1003–14.CrossRefGoogle Scholar
  50. 50.
    Rohof WO, et al. Effect of azithromycin on acid reflux, hiatus hernia and proximal acid pocket in the postprandial period. Gut. 2012;61(12):1670–7.CrossRefGoogle Scholar
  51. 51.
    Koek G, et al. Effect of the GABAB agonist baclofen in patients with symptoms and duodeno-gastro-oesophageal reflux refractory to proton pump inhibitors. Gut. 2003;52(10):1397–402.CrossRefGoogle Scholar
  52. 52.
    Grossi L, et al. Effect of baclofen on oesophageal motility and transient lower oesophageal sphincter relaxations in GORD patients: a 48-h manometric study. Neurogastroenterol Motil. 2008;20(7):760–6.CrossRefGoogle Scholar
  53. 53.
    Vela M, et al. Baclofen decreases acid and non-acid post-prandial gastro-oesophageal reflux measured by combined multichannel intraluminal impedance and pH. Aliment Pharmacol Ther. 2003;17(2):243–51.CrossRefGoogle Scholar
  54. 54.
    Orr W, et al. The effect of baclofen on nocturnal gastroesophageal reflux and measures of sleep quality: a randomized, cross-over trial. Neurogastroenterol Motil. 2012;24(6):553–e253.CrossRefGoogle Scholar
  55. 55.
    Cange L, et al. Baclofen-mediated gastro-oesophageal acid reflux control in patients with established reflux disease. Aliment Pharmacol Ther. 2002;16(5):869–73.CrossRefGoogle Scholar
  56. 56.
    Ronkainen J, et al. High prevalence of gastroesophageal reflux symptoms and esophagitis with or without symptoms in the general adult Swedish population: a Kalixanda study report. Scand J Gastroenterol. 2005;40(3):275–85.CrossRefGoogle Scholar
  57. 57.
    Shaw MJ, et al. When does simple heartburn become a diseases? Gastroenterology. 1998;114:A284.CrossRefGoogle Scholar
  58. 58.
    Charan M, Katz PO. Gastroesophageal reflux disease in pregnancy. Curr Treat Options Gastroenterol. 2001;4(1):73–81.CrossRefGoogle Scholar
  59. 59.
    Anton CR, Anton E, Stanciu C. Gastroesophageal reflux disease in pregnancy. Rev Med Chir Soc Med Nat Iasi. 2001;105(1):43–7.PubMedGoogle Scholar
  60. 60.
    Broussard CN, Richter JE. Treating gastro-oesophageal reflux disease during pregnancy and lactation: what are the safest therapy options? Drug Saf. 1998;19(4):325–37.CrossRefGoogle Scholar
  61. 61.
    Riley A, Crowley P, Harrison C. Transfer of ranitidine to biological fluids: milk and semen. In: The clinical use of ranitidine, Medicine Publishing Foundation Series, vol. 5. Oxford: Medicine Publishing Foundation; 1982. p. 77–86.Google Scholar
  62. 62.
    Kearns G, et al. Appearance of ranitidine in breast milk following multiple dosing. Clin Pharm. 1984;4(3):322–4.Google Scholar
  63. 63.
    Knigge UP. Histaminergic regulation of prolactin secretion. Dan Med Bull. 1990;37(2):109–24.PubMedGoogle Scholar
  64. 64.
    Perret G, et al. Effect of a short-term oral administration of cimetidine and ranitidine on the basal and thyrotropin-releasing hormone-stimulated serum concentrations of prolactin, thyrotropin and thyroid hormones in healthy volunteers. Pharmacology. 1986;32(2):101–8.CrossRefGoogle Scholar
  65. 65.
    Lewis J, Weingold A. The use of gastrointestinal drugs during pregnancy and lactation. Am J Gastroenterol. 1985;80(11):912–23.PubMedGoogle Scholar
  66. 66.
    Hagemann TM. Gastrointestinal medications and breastfeeding. J Hum Lact. 1998;14(3):259–62.CrossRefGoogle Scholar
  67. 67.
    Chen C-L, Hsu P-I. Current advances in the diagnosis and treatment of nonerosive reflux disease. Gastroenterol Res Pract. 2013;2013:653989.PubMedPubMedCentralGoogle Scholar
  68. 68.
    Dean BB, et al. Effectiveness of proton pump inhibitors in nonerosive reflux disease. Clin Gastroenterol Hepatol. 2004;2(8):656–64.CrossRefGoogle Scholar
  69. 69.
    Storr MA. What is nonacid reflux disease? Can J Gastroenterol. 2011;25(1):35–8.CrossRefGoogle Scholar
  70. 70.
    Hachem C, Shaheen NJ. Diagnosis and Management of Functional Heartburn. Am J Gastroenterol. 2016;111(1):53–61; quiz 62.CrossRefGoogle Scholar
  71. 71.
    Kavitt RT, et al. Symptom reports are not reliable during ambulatory reflux monitoring. Am J Gastroenterol. 2012;107(12):1826–32.CrossRefGoogle Scholar
  72. 72.
    Rosen R, et al. Intraesophageal pressure recording improves the detection of cough during multichannel intraluminal impedance testing (pH-MII) in children. J Pediatr Gastroenterol Nutr. 2014;58(1):22.CrossRefGoogle Scholar
  73. 73.
    Limsrivilai J, et al. Imipramine for treatment of esophageal hypersensitivity and functional heartburn: a randomized placebo-controlled trial. Am J Gastroenterol. 2016;111(2):217–24.CrossRefGoogle Scholar
  74. 74.
    Prakash C, Clouse RE. Long-term outcome from tricyclic antidepressant treatment of functional chest pain. Dig Dis Sci. 1999;44(12):2373–9.CrossRefGoogle Scholar

Copyright information

© SAGES 2019

Authors and Affiliations

  • Feng Li
    • 1
  • Stephanie Denise Pointer
    • 1
  • Jon P. Walker
    • 1
    Email author
  1. 1.Division of Gastroenterology, Hepatology, and NutritionThe Ohio State University Wexler Medical CenterColumbusUSA

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