Gastrointestinal pharmacology: practical tips for the esophagologist,Annals of the New York Academy of Sciences

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Gastrointestinal pharmacology: practical tips for the esophagologist
Annals of the New York Academy of Sciences ( IF 4.1 ) Pub Date : 2020-08-21 , DOI: 10.1111/nyas.14447
Carmelo Scarpignato _{1,

2} , Joshua A Sloan ₃ , David H Wang ₄ , Richard H Hunt ₅

Affiliation

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.

中文翻译：

胃肠药理学：食道科医生的实用技巧

胃食管反流病 (GERD) 主要是一种运动障碍，其发病机制是多因素的。因此，治疗应该能够解决潜在的病理生理学问题。质子泵抑制剂 (PPI) 是 GERD 药物治疗的中流砥柱，但这些药物只能控制症状和病变，而不能治愈疾病。然而，建议对 Barrett 食管患者使用 PPI 持续抑酸，因为它们具有潜在的化学预防作用。除了抗分泌活性外，这些化合物还显示出多种药理特性，但在临床实践中常常被忽视。PPI 确实可以影响胃动力，发挥粘膜保护作用，以及抗氧化、抗炎和抗肿瘤活性，还可以保护癌细胞免于产生化疗或放疗耐药性。即使在第三个千年，目前治疗 GERD 的药理学方法也是有限的。反流抑制剂代表着未实现的承诺，缺乏有效和安全的促动力作用，抗抑郁药尽管对选定的患者有效，但在其中很大一部分会引起不良事件。在等待新药物类别（如钾竞争性酸阻滞剂）的同时，重新评估旧药物（即含海藻酸盐的制剂）并为食管粘膜保护铺平新途径，是目前唯一可靠的抑酸替代方法。缺乏有效和安全的促动力药，抗抑郁药尽管对选定的患者有效，但在其中很大一部分会引起不良事件。在等待新药物类别（如钾竞争性酸阻滞剂）的同时，重新评估旧药物（即含海藻酸盐的制剂）并为食管粘膜保护铺平新途径，是目前唯一可靠的抑酸替代方法。缺乏有效和安全的促动力药，抗抑郁药尽管对选定的患者有效，但在其中很大一部分会引起不良事件。在等待新药物类别（如钾竞争性酸阻滞剂）的同时，重新评估旧药物（即含海藻酸盐的制剂）并为食管粘膜保护铺平新途径，是目前唯一可靠的抑酸替代方法。

更新日期：2020-08-21

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