Recent advances in the management of gastro-oesophageal reflux disease

Analysis of medical compliance in gastro-oesophageal reflux disease patients referred to pre-surgical examination

BACKGROUND

Despite potential of modern pharmacotherapy to control gastro-oesophageal reflux disease and also to improve patients' quality of life, an efficient long-term management always depends on patients compliance with medication.

AIMS

To evaluate and analyse potential aspects of compliance or non-compliance with medical and clinical prescriptions in a selected group of gastro-oesophageal reflux disease patients referred to pre-surgical examination because of persistent or recurrent symptoms.

PATIENTS

A total of 182 gastro-oesophageal reflux disease patients have been divided by patient rating to 3 different subgroups: group 1/TC consisted of patients who subjectively stated to be totally compliant (n=71; 39%); group 2/PC of patients with partial compliance (n=65; 36%), and group 3/NC consisted of patients with non-compliance (n=46; 25%) in relation to the prescriptions of their doctor taking care of their treatment.

METHODS

All patients have been asked for potential aspects of compliance or non-compliance. The following aspects have been analysed: understandable medical prescription, information about gastro-oesophageal reflux disease, subjective severity of gastro-oesophageal reflux disease-related symptoms, severity of disease, side-effects of medication, general rejection of medication, multi-medication, patient age and sex, quality of life, and a specific construct of personality (health locus of control).

RESULTS

Significant differences could be calculated between patients' age and gender showing that female and elderly patients are more compliant with medication. Group 1/TC patients suffered from a significantly longer period of symptoms and received medication for a longer period when compared to the other groups. Quality of life was impaired in all patients but patients in group 3/NC had a significantly better quality of life than patients in group 1/TC. The leading aspects for total compliance were: an understandable medical prescription (95%), high severity of perceived symptoms (76%) and of disease (88%). The major factors in group 2/PC patients have been unclear information about gastro-oesophageal reflux disease (41%), mild severity of perceived symptoms (59%), low severity of disease (30%), and a general rejection of medical treatment (21%). General rejection of drug treatment has been the major factor in group 3/NC patients (80%) which can be viewed in relation to patients' personality

CONCLUSION

Compliance or non-compliance in this selected group of patients depended on several factors such as information, subjective severity of symptoms, severity of disease but, in addition, on patients' personality Therefore, new strategies for compliance with long-term treatment in gastro-oesophageal reflux disease patients should be discussed.

Mucosal protective effect of leminoprazole on reflux esophagitis induced in rats

We examined the effect of leminoprazole (an acid pump inhibitor) on reflux esophagitis induced in rats. Intragastrically administered leminoprazole significantly and dose-dependently protected the esophageal mucosa against the reflux of gastric contents, without affecting gastric acid secretion. However, it had no effect on the esophagitis when administered intraduodenally, despite its significant inhibition (about 40%) of gastric acid secretion. Omeprazole significantly prevented the development of esophagitis, most probably through potent inhibition of gastric acid secretion. Indomethacin significantly reduced the synthesis of prostaglandin E2 in the esophagus. Since indomethacin pretreatment had no effect on the esophageal protection by leminoprazole, omeprazole or sucralfate, the involvement of endogenous prostaglandins can be ruled out as a possible underlying mechanism. Intragastrically, but not intraduodenally, administered sucralfate significantly prevented the esophagitis even at a dose not affecting gastric acid secretion. These results strongly suggest that both leminoprazole and sucralfate protect the esophageal mucosa directly.

Review article: drug therapy for reflux oesophagitis

Gastro-oesophageal reflux disease is a common disorder and symptoms can be mild to severe. Management of the disease should be individualized. Life-style changes are important for all patients. Drug therapy is often necessary but only very few patients with severe disease need surgical treatment. The purpose of this article is to focus on drug therapy and to review the clinical trials of all the drugs used for gastro-oesophageal reflux disease. Thereafter, judged solely on the data derived from these trials, a practical approach to the management of gastro-oesophageal reflux disease is suggested.