应用Applications of Acid Suppression.docVIP

Medscape Gastroenterology Applications of Acid Suppression in the Treatment of Gastroesophageal Reflux Disease Brooks D. Cash, MD, FACP, FACG Introduction Gastroesophageal reflux disease (GERD) is one of the most common clinical conditions encountered in primary care and general gastroenterology practices. Defined as reflux of gastric contents into the esophagus, GERD is seen across all age groups and has a prevalence in the adult population of 15% to 20%. GERD is associated with significant health resource utilization and impairment in the quality of life in affected patients.[1] Left untreated, patients with chronic GERD have the potential to develop a number of complications, including but not limited to erosive esophagitis, esophageal strictures, Barretts esophagus, and esophageal adenocarcinoma. The development of effective acid-suppressing medications, such as histamine type-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs), heralded a tremendous advance in the management of patients with GERD, and these 2 classes of medications represent a significant percentage of the prescriptions in the world today. There is abundant clinical evidence that the acid suppression that is achieved with PPIs is more pronounced and durable than that achieved with H2RAs, and, since their introduction into the US market in 1993, PPIs have largely supplanted the other acid-suppressing medications to become the cornerstone of therapy for GERD sufferers and other acid-peptic conditions. Although the worldwide experience with PPIs is vast, we continue to gain new insights related to GERD and its management. During this years Digestive Disease Week (DDW) meeting, emerging research was presented in regard to the clinical applications and outcomes that have been observed with PPIs for the treatment of GERD. This report summarizes much of this emerging research. Predicting Response to PPIs Although PPIs have proven to be remarkably effective therapy for GERD and other acid