Evidence that changes the way you practise: the pharmacological management of gastro-oesophageal reflux disease

Abstract

Gastro-oesophageal reflux disease (GORD) is defined as a chronic symptom-based disease that affects the upper gastrointestinal tract, resulting in mucosal damage caused by the retrograde flow of gastric acid from the stomach through an incompetent cardiac sphincter into the lower oesophagus. Typically, symptoms include dyspepsia, epigastric pain, heartburn, belching, bloating, nausea, early satiation and postprandial fullness. Several risk factors have been identified, which mainly include alcohol (15%), aspirin and nonsteroidal anti-inflammatory drugs (25%), corticosteroids, obesity and pregnancy (10%), hiatal hernias (60-80%), hypercalcaemia, Helicobacter pylori infection (40-90%) and hypersecretory states (Zollinger-Ellison syndrome). Complications of GORD include non-oesophageal reflux disease, erosive oesophagitis, Barrett’s oesophagus and adenocarcinoma. A study in the USA showed that GORD was responsible for the greatest direct cost of any gastrointestinal disease, and most of that expenditure was on pharmacotherapy. The pharmacological management of GORD will be the focus of this article.