Esophageal reflux

The sales of antagonists of receptors, eg, diphenhydramine, terfenadine, and astemizole, used in the treatment of allergic diseases, represent 1% of the overall pharmaceutical market, ie, 1.7 biUion (U.S.). antagonists, eg, cimetidine and ranitidine, are effective in peptic ulcer disease and esophageal reflux. Sales represent 3.5% of the world market, ie, 6 biUion (U.S.). agonists or antagonists have not yet found a clear indication. 

Non-cardiac Anemia, anxiety disorders, carbon monoxide poisoning, cocaine use, esophageal reflux, peptic ulcer, pleuritis, pneumonia, pneumothorax, pulmonary embolus, pulmonary hypertension, thyrotoxicosis... 

Bisphosphonates Dyspepsia, esophageal reflux, esophageal pain or burning. 

Stipa F., Stein H.J., Feussner H., Kraemer S., Siewert J.R., Assessment of non-acid esophageal reflux comparison between long-term reflux aspiration test and fibeoptic bilirubin monitoring, Dis. Esophagus 1997 10 1. 

R.D. Jones, M.R. Neuman, G. Sanders, and F.T. Cross, Miniature antimony pH electrodes for measuring gastro esophageal reflux. Ann. Thoracic Surg. 33, 191 195 (1982). 

The answer is d. (Hardman, pp 907-909J Omeprazole inhibits H+,K+,ATPase, which effectively stops the proton pump and thus prevents the formation of gastric acid. It is the most effective agent in severe cases of ulceration and esophageal reflux. 

Esophagus (Big Blue FI lad transgenic rats) Increased duodeno-gastric-esophageal reflux Significant increase in lad mutations 43... 

Bixquert M. Maintenance therapy in gastro-esophageal reflux disease. Drugs. 2005 65(suppl l) 59-66. 

ZacnyJ, Zamakhshary M, Sketris I, et al. Systematic review the efficacy of intermittent and on-demand therapy with histamine H2-receptor antagonists or proton pump inhibitors for gastro-esophageal reflux disease patients. Aliment Pharmacol Ther. 2005 21 1299-1312. 

The effect of cisapride 0.8 mg/kg/day for 14 days on the QTc interval has been stndied prospectively in 50 infants with feeding intolerance, apnea, and bradycardia episodes secondary to gastro-esophageal reflux and gastrointestinal dysmotUity (9). In 15 infants there was prolongation of the QTc interval at some time during the 14 days. Infants with a QTc interval on day 3 at least two standard deviations above the mean baseline QTc interval were more likely to develop a prolonged QTc interval. 

Electrocardiographic changes and predisposition to cardiac dysrhythmias were investigated in 63 children (mean age 29 months) with gastro-esophageal reflux who had taken cisapride 0.2 mg/kg tds for at least 15 days and 57 control children (mean age 27 months) who were hospitalized for other reasons and were not given cisapride or other oral treatment (13). All the children... 

A multicenter trial in 353 patients assessed the efficacy and tolerance of sodium alginate (four 10 ml sachets a day) compared with cisapride (5 mg qds) in the symptomatic treatment of uncomplicated gastro-esophageal reflux without severe esophagitis (21). Sodium alginate, which costs less than cisapride, was more effective in relieving symptoms. Adverse effects were rare and not serious. Constipation was the most common adverse effect of alginate while diarrhea was the commonest adverse effect of cisapride. 

A systematic review of randomized, controlled trials of cisapride for gastro-esophageal reflux in children has been reported (26). Seven comparisons of cisapride with placebo (286 children in all) were included. The reflux index was significantly reduced by cisapride. However, there was no clear evidence that cisapride reduced symptoms of gastro-esophageal reflux. Adverse events (mainly diarrhea) were not significantly more common with cisapride. 

The third infant was given aminophylline orally and doxapram by intravenous infusion 5 days later cisapride was added to treat suspected gastro-esophageal reflux. The next day the infant had developed second-degree AV block, with a prolonged QT interval. Doxapram was withdrawn and sinus rhythm returned 36 hours later. 

To assess symptom control, esomeprazole 20 mg on demand has been compared with placebo on demand (maximum of one dose a day) for 6 months in a multicenter, double-blind study in 342 endoscopy-negative patients with gastro-esophageal reflux disease (2). There was complete resolution of heartburn after 4 weeks of daily esomeprazole therapy. On-demand therapy with esomeprazole was significantly more effective than placebo in controlling symptoms. The frequencies of adverse effects and laboratory profiles were similar in the two groups when adjusted for the time spent in the study. 

Vitamin B12 deficiency has been reported in a 78-year-old non-vegetarian white woman with gastro-esophageal reflux who had taken H2 receptor antagonists and omeprazole for 4.5 years (9). 

Omeprazole, in a starting dose of 0.7 mg/kg/day, was effective in the treatment of severe esophageal reflux after failed fundoplication in 18 children (mean age at presentation 7.8 years) over a mean follow-up period of 4.4 years (30). It was also well tolerated. A hyperplastic polyp was noted in one child after 38 months of treatment and persisted without any dysplastic change. One to three gastric nodules were seen in three children after a mean of 45 months histology of the nodules showed only mucosal edema. 

Pantoprazole 20 mg/day and ranitidine 300 mg/day for 12 months have been compared in the relief of symptoms in a multicenter, randomized, double-blind trial in 307 patients with symptomatic gastro-esophageal reflux disease in primary care (3). Symptom control was significantly more effective and faster with pantoprazole than ranitidine. Adverse effects were similar in the two groups the most common adverse effects were headache, diarrhea, nausea, constipation, and vomiting. 

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