New therapies for gastroesophageal reflux disease.

It is estimated that approximately 30% of the GERD patients is not satisfied about the effect of proton pump inhibitors on their symptoms. Esophageal hypersensitivity, persistent non-acid reflux and incomplete acid suppression all can play a role in the pathogenesis of persistent GERD symptoms. More powerful inhibitors of the proton pump are now being developed, resulting in a more prolonged and profound acid suppression. New prokinetics and inhibitors of transient lower esophageal sphincter relaxations (TLESRs) can potentially reduce both acid and non-acid reflux and drugs that reduce hypersensitivity are possibly helpful for the treatment of non-erosive reflux disease. Whether these drugs will make it to the markets will mainly depend on their side effect profile and their ability to have an additional beneficial effect over the current gold standard therapy as it likely that a new antireflux drug will be used in combination with proton pump inhibitors. Over the last decade various endoscopic antireflux techniques have been introduced, most of them have been withdrawn soon after introduction due to lack of effect or after the occurrence of severe side-effects. Several endoluminal plication techniques and endoluminal radiofrequency ablation therapy are still available and being evaluated in research centres but more data on safety and efficacy is required before a more widespread use can be advised.