Many gastroesophageal reflux disease (GERD) patients in Asia still experience the symptoms of GERD even though they are compliant to proton pump inhibitor (PPI) therapy, reveals a survey.

The GERD in Asia Pacific Survey (GAPS) enrolled 450 patients from six Asian countries. The participants were aged between 21 and  55 years, with self-reported and doctor-diagnosed GERD. All participants were on PPI therapy and had experienced symptoms in the past year. [J Gastroenterol Hepatol 2014; doi:10.1111/jgh.12655]

The aim of the study was to examine Asian patients’ perspectives on GERD and PPIs. GAPS showed that patients were still experiencing symptoms despite good compliance with PPI therapy. Before starting treatment, 94 percent of participants reported that the disease had a negative impact on their well-being. After treatment, the figure improved only slightly to 76 percent. On top of that, 49 percent of participants had to continue adjunctive treatment to manage their symptoms. However, more than 70 percent of participants reported that PPIs obliterated pain, was effective within 30 minutes, gave nocturnal relief and sustained relief. [J Gastroenterol Hepatol 2014; doi:10.1111/jgh.12655]

Management of GERD involves lifestyle changes, medication and surgery. Lifestyle changes include weight reduction and sleeping with the head of the bed elevated. Medical therapy targets gastric acid secretion, and the common agents are H2-receptor antagonists (H2RAs), antacids and PPIs. An analysis of 32 randomized controlled trials found that PPIs were more effective than H2RAs and prokinetics in relieving dyspepsia in patients with GERD. [Cochrane Database Syst Rev 2010;(11):CD002095]

The effectiveness of PPIs correlates with their structures. PPIs need to undergo acidic activation in the parietal cell so that they become ionized and form covalent disulfide bonds with cysteines of the H(+)-K(+)-adenosine triphosphatase (H(+)-K(+)-ATPase). After the PPI binds to the proton pump, the pump becomes inactivated. Some PPIs such as omeprazole bind to cysteines that are exposed, and their binding can be reversed. [Pediatr Drugs 2013;15(2):119-31]

For patients whose symptoms persist even after lifestyle modification and medical treatment, surgery may be required.

GERD is a common disease that can manifest in numerous ways, which can be grouped into typical, atypical and extra-esophageal symptoms. The symptoms that are most specific for GERD are acid regurgitation and heartburn. Complications that may occur in this disease include esophageal adenocarcinoma, erosive esophagitis, peptic stricture, Barrett’s esophagus and pulmonary disease.

nguồn: PMC