Gastrointestinal pharmacology: practical tips for the esophagologist

Carmelo Scarpignato, Joshua A. Sloan, David H. Wang, Richard H. Hunt

Research output: Contribution to journalReview articlepeer-review

Abstract

Gastroesophageal reflux disease (GERD) is primarily a motor disorder, and its pathogenesis is multifactorial. As a consequence, treatment should be able to address the underlying pathophysiology. Proton pump inhibitors (PPIs) are the mainstay of medical therapy for GERD, but these drugs only provide the control of symptoms and lesions without curing the disease. However, continuous acid suppression with PPIs is recommended for patients with Barrett's esophagus because of their potential chemopreventive effects. In addition to the antisecretory activity, these compounds display several pharmacological properties, often overlooked in clinical practice. PPIs can indeed affect gastric motility, exert a mucosal protective effect, and an antioxidant, anti-inflammatory, and antineoplastic activity, also protecting cancer cells from developing chemo- or radiotherapeutic resistance. Even in the third millennium, current pharmacologic approaches to address GERD are limited. Reflux inhibitors represent a promise unfulfilled, effective and safe prokinetics are lacking, and antidepressants, despite being effective in selected patients, give rise to adverse events in a large proportion of them. While waiting for new drug classes (like potassium-competitive acid blockers), reassessing old drugs (namely alginate-containing formulations), and paving the new avenue of esophageal mucosal protection are, at the present time, the only reliable alternatives to acid suppression.

Original languageEnglish (US)
Pages (from-to)90-107
Number of pages18
JournalAnnals of the New York Academy of Sciences
Volume1481
Issue number1
DOIs
StatePublished - Nov 10 2020
Externally publishedYes

Bibliographical note

Funding Information:
C.S. has served as a speaker, consultant, and/or advisory board member for Alfasigma, Pfizer, Takeda, Reckitt-Benkiser, and Shionogi, and has in the past received funding from Giuliani Pharmaceuticals and Pfizer. R.H.H. has served as a speaker, consultant, and an advisory board member for AstraZeneca, Danone, GSK, Merck, Pfizer, and Takeda. J.A.S. and D.H.W. declare no competing interests.

Publisher Copyright:
© 2020 New York Academy of Sciences.

Keywords

  • Barrett's esophagus
  • GERD
  • NSAIDs
  • P-CABs
  • PPIs
  • alginate-containing formulations
  • aspirin
  • chemoprevention

PubMed: MeSH publication types

  • Journal Article
  • Review

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