New therapeutic options in the treatment of GERD and other acid-peptic disorders. Based on a presentation by Duane D. Webb, MD, FACG.

Gastroesophageal reflux disease (GERD), or the regurgitation of gastric content into the esophagus, is an acid-peptic disorder that has a significant impact on both health and the quality of life. Because gastric acid plays a major role in the pathophysiology of this disease, acid neutralization/suppression has emerged as the cornerstone of GERD therapy. Currently, there are 3 classes of drugs used to increase gastric pH: antacids, histamine2 receptor antagonists (H2RAs), and proton pump inhibitors (PPIs). Antacids act by neutralizing the pH of the stomach. However, because of their limited efficacy and short duration of action, they have not been shown to be effective in either the prevention or healing of GERD-induced esophageal injury. Moreover, numerous doses per day are often required to control GERD symptoms. A second class of agents, H2RAs, act by inhibiting a histamine-dependent biochemical pathway that stimulates acid secretion by the gastric parietal cell. However, because there are several other stimulatory pathways that also contribute to acid secretion, a lack of consistent efficacy of H2RAs exists among individuals. Moreover, because there are several pathways leading to acid secretion, patients who receive H2RAs often experience tachyphylactic reactions to these drugs. The PPIs are the latest and most effective medications for the treatment of GERD. Unlike H2RAs, PPIs block acid secretion at its source--the proton pump of the gastric parietal cell. Studies have consistently shown that PPIs are more effective than H2RAs in resolving GERD symptoms, healing erosive esophagitis, and preventing esophageal injuries. PPIs are also effective in the treatment of acid-peptic disorders other than GERD, such as duodenal and gastric ulcers. Four PPIs are currently available in the United States: omeprazole, lansoprazole, rabeprazole, and pantoprazole.