Acid reflux disease

The proton pump inhibitors are used for treatment or symptomatic relief of various gastric disorders, including gastric and duodenal ulcers, GERD, or pathological hypersecretory conditions. Painful, persistent heartburn 2 or more days a week may indicate acid reflux disease which can erode the delicate lining of the esophagus,... 

Also known as acid reflux disease as advertised, at the time of writing, for example, by the makers of Prevacid in TV commercials in the United States. 

Kahrilas PJ, Fennerty MB, Joelsson B. High- versus standard-dose ranitidine for control of heartburn in poorly responsive acid reflux disease a prospective, controlled trial. Am J Gastroenterol 1999 94(l) 92-7. 

A proton pump inhibitor used in the treatment of ulcers and acid reflux disease... 

Hour ambulatory pH monitoring may be the only way to objectively prove that symptoms are reflux-related in patients with atypical symptoms or non-erosive reflux disease. Ambulatory pH monitoring may also be useful in patients whose symptoms are not improving on adequate doses of acid-suppressing therapy. 

Concurrent colonization by Gram-negative bacilli occurs in some patients with failure of the gastric acid barrier, suggesting additional deficiencies of host defense abnormal oral flora, malnutrition, general illness, or diseases or medication interfering with intestinal peristalsis and clearance. This type of microflora is also seen in 10-30% of patients on acid inhibitors, for which mucosal injury and functional changes related to peptic ulcer and reflux disease may be responsible. 

Proton pump inhibitors (PPIs), such as omeprazole, esomeprazole, lansoprazole, pantoprazole, and rabeprazole, are commonly prescribed to treat symptoms of heartburn, acid reflux, chest pain, dyspepsia, and chronic cough. PPIs inhibit the transfer of protons into the stomach lumen. Pharmacological acid suppression is thus used to treat gastroesophageal reflux disease (GERD) and esophagitis, peptic ulcers, and Helicobacter pylori infection as well as to prevent ulcer development with concurrent nonsteroidal anti-inflammatory drug use. 

W. K. Kauer, J. H. Peters, T. R. DeMeester and A. P. Ireland, Composition and Concentration of Bile Acid Reflux into the Esophagus of Patients with Gastroesophageal Reflux Diseases, Surgery, 1997, 122(5), 874-81. 

D. Nehra, P. Howell, C. P. Williams, J. K. Pye and J. Beynon, Toxic bile acids in gastro-oesophageal reflux disease influence of gastric acidity, Gut, 1999, 44(5), 598. 

Ranitidine is a histamine receptor antagonist. It acts essentially on the H2 receptor and blocks acid production. Ranitidine is used in the treatment and prevention of ulcers, NSAID-induced ulcers, Zollinger-Ellison syndrome and gastro-oesophageal reflux disease. 

Omeprazole (p. 167) can cause maximal inhibition of HCl secretion. Given orally in gastric juice-resistant capsules, it reaches parietal cells via the blood. In the acidic milieu of the mucosa, an active metabolite is formed and binds covalently to the ATP-driven proton pump (H+/K+ ATPase) that transports H+ in exchange for IC into the gastric juice. Lansoprazole and pantoprazole produce analogous effects. The proton pump inhibitors are first-line drugs for the treatment of gastroesophageal reflux disease. 

H2 antagonists are clinically used in the treatment of acid-related gastrointestinal conditions. Specifically, these indications may include peptic ulcer disease, gastroesophageal reflux disease, and dyspepsia. 

Table 1. Acid neutralising or inhibiting regimes in oesophageal reflux disease...

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