lesogaberan and arbaclofen-placarbil

The management of patients with refractory GERD (rGERD) is a major clinical challenge for gastroenterologists. In up to 30% of patients with typical GERD symptoms (heartburn and/or regurgitation), acid-suppressive therapy does not provide clinical benefit. In this Review, we discuss the current management algorithm for GERD and the features and management of patients who do not respond to treatment (such as those individuals with an incorrect diagnosis of GERD, inadequate PPI intake, persisting acid reflux and persisting weakly acidic reflux). Symptom response to existing surgical techniques, novel antireflux procedures, and the value of add-on medical therapies (including prokinetics and reflux inhibitors) for rGERD symptoms are discussed. Pharmaceutical agents targeting oesophageal sensitivity, a condition that can contribute to symptom generation in rGERD, are also discussed. Finally, on the basis of available published data and our expert opinion, we present an outline of a current, usable algorithm for management of patients with rGERD that considers the timing and diagnostic use of pH-impedance monitoring on or off PPI, additional diagnostic tests, the clinical use of baclofen and the use of add-on neuromodulators (tricyclic agents and selective serotonin reuptake inhibitors).

Topics: Alginates; Algorithms; Antacids; Baclofen; Chronic Disease; Esophagoscopy; Gastroesophageal Reflux; Gastrointestinal Agents; Gastroscopy; Humans; Isoxazoles; Muscle Relaxants, Central; Neurotransmitter Agents; Phosphinic Acids; Propylamines; Triazoles

Topics: Baclofen; GABA-B Receptor Agonists; Gastroesophageal Reflux; Humans; Phosphinic Acids; Propylamines; Receptor, Metabotropic Glutamate 5; Receptors, Metabotropic Glutamate

Proton pump inhibitors (PPIs) are the gold standard treatment for gastroesophageal reflux disease. In clinical practice, failure of PPIs occurs frequently, and may affect up to 30% of patients in a typical gastroenterology practice. Multichannel impedance monitoring combined with pH monitoring helps to detect nonacid reflux, and if symptoms correlate with these nonacid reflux episodes, nonacid reflux disease can be diagnosed. In contrast to PPIs, reflux inhibitors target transient lower esophageal sphincter relaxations, which are involved in the pathophysiology of reflux disease and may be the appropriate future treatment for nonacid reflux disease. The present article discusses the current understanding of nonacid reflux disease, its diagnosis and treatment.

Topics: Baclofen; Esophageal Sphincter, Lower; Gastroesophageal Reflux; Humans; Phosphinic Acids; Propylamines; Proton Pump Inhibitors; Receptors, GABA-A