The introduction of acid inhibition in clinical practice has revolutionized the management of acid‐related diseases, leading to the virtual abolition of elective surgery for ulcer disease and relegating antireflux surgery to patients with gastroesophageal reflux disease (GERD) not adequately managed by medical therapy. Proton pump inhibitors (PPIs) are the antisecretory drugs of choice for the treatment of reflux disease. However, these drugs still leave some unmet clinical needs in GERD. PPI‐refractoriness is common, and persistent symptoms are observed in up to 40–55% of daily PPI users. Potassium‐competitive acid blockers (P‐CABs) clearly overcome many of the drawbacks and limitations of PPIs, achieving rapid, potent, and prolonged acid suppression, offering the opportunity to address many of the unmet needs. In recent years, it has been increasingly recognized that impaired mucosal integrity is involved in the pathogenesis of GERD. As a consequence, esophageal mucosal protection has emerged as a new, promising therapeutic avenue. When P‐CABS are used as add‐on medications to standard treatment, a growing body of evidence suggests a significant additional benefit, especially in the relief of symptoms not responding to PPI therapy. On the contrary, reflux inhibitors are considered a promise unfulfilled, and prokinetic agents should only be used on a case‐by‐case basis.

中文翻译：

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GERD的药物治疗：我们现在在哪里，我们要去哪里？

在临床实践中引入抑酸剂彻底改变了酸相关疾病的管理，导致溃疡病的择期手术实际上被取消，并将抗反流手术降级到无法通过药物治疗充分管理的胃食管反流病 (GERD) 患者。质子泵抑制剂 (PPI) 是治疗反流病的首选抗分泌药物。然而，这些药物在 GERD 中仍有一些未满足的临床需求。PPI 难治性很常见，并且在高达 40-55% 的每日 PPI 使用者中观察到持续症状。钾竞争性酸阻滞剂 (P-CAB) 显然克服了 PPI 的许多缺点和局限性，实现了快速、有效和持久的酸抑制，为解决许多未满足的需求提供了机会。最近几年，人们越来越认识到，受损的粘膜完整性参与了 GERD 的发病机制。因此，食管黏膜保护已成为一种新的、有前途的治疗途径。当 P-CABS 被用作标准治疗的附加药物时，越来越多的证据表明显着的额外益处，尤其是在缓解 PPI 治疗无反应的症状方面。相反，反流抑制剂被认为是未兑现的承诺，促动力剂只能根据具体情况使用。越来越多的证据表明显着的额外益处，尤其是在缓解对 PPI 治疗无反应的症状方面。相反，反流抑制剂被认为是未兑现的承诺，促动力剂只能根据具体情况使用。越来越多的证据表明显着的额外益处，尤其是在缓解对 PPI 治疗无反应的症状方面。相反，反流抑制剂被认为是未兑现的承诺，促动力剂只能根据具体情况使用。