Gastroesophageal
Reflux Disease
Gastroesophageal
Reflux Disease (GERD)
“a prevalent and chronic condition in which reflux of the stomach
contents into the oesophagus causes a range of troublesome
symptoms (including heartburn, acid regurgitation and epigastric
pain) and complications”
Vakil et al. The Montreal definition and classification of GERD: a
global evidence-based consensus. Am J Gastroenterol. 2006
GERD causes disruption of physical, social and emotional wellbeing, reflux oesophagitis, haemorrhage, stricture, Barrett’s
oesophagus and adenocarcinoma of the distal oesophagus;
Prevalence: 20% of USA adult population (Sonnenberg et al,
1999) and similar results in Europe (Nazi et al 2006).
Sintomatology






Typical
symptoms:
heartburn
regurgitation
Others
symptoms:
chronic cough
wheezing
hoarseness
chest pain
Proton Pumps Inhibitors (PPIs)
it primary function is the
inhibition of acid production in
the final common metabolic
pathway of gastric parietal cells;
It has an anti-secretory and
anti-ulcer activities;
It accelerates the spontaneous
healing of acetic acid-induced
gastric ulcers;
When combined with two or
three antibiotics, are used for the
eradication of Helicobacter pylori
(Hp).
Proton Pumps Inhibitors
(PPIs)
All PPIs dose-dependently inhibit gastric acid
secretion and raise intragastric pH for 24–48 h;
Intragastric pH should be maintained above 3.5
to heal peptic ulcer and above 4 to heal
gastroesophageal reflux disease.
These findings suggest that therapeutic efficacy
depends on drug dose and dosing interval.
Proton Pumps Inhibitors
(PPIs)
The area under the plasma concentration-vs.-time curve
(AUC) is closely related to the inhibition of gastric secretion.
Omeprazole (20 mg)
Omeprazole exerts a prolonged anti-secretory effect.
“Twice daily dosing of Omeprazole
20mg b.d. appears to be significantly
more effective than Lanzoprazole 30mg
b.d. in controlling gastric acidity.”
Katz PO, Hatlebakk JG, Castell DO.
LANZOprazole (30 mg)
Side effects:
 Headache
 Diarrhea
 Dizziness
 Nausea
Lanzoprazole tends to relief symptoms more rapidly
than Omeprazole, although initial healing is similar;
It is an important alternative to Omeprazole.
RABEprazole (20 mg)
Rabeprazole can achieve more than 90%
of eradication rates;
It is as effective as Omeprazole and
Lansoprazole when included as part of a
triple-therapy regimen;
Side effects:
 Diarrhea
 Headache
 Rhinitis
 Nausea
 Pharyngitis
 Abdominal pain.
PANTOprazole (40 mg)
Side effects:




diarrhea
headache
stomach pain
gas or bloating
ESOMEprazole (40 mg)
Decreases the chance of getting an ulcer in
people who are taking nonsteroidal antiinflammatory medications (NSAIDs);
Treats and prevents the return of stomach
ulcers caused by a certain type of bacteria
(H. pylori), with other medications;
More including than pantoprazole ;
Esomeprazole has more side effects than
the others PPIs, and some of them are also
much more serious.
ESOMEprazole (40 mg)
difficulty breathing or
swallowing;
 swelling of the face,
throat, tongue, lips, eyes,
hands, feet, ankles, or
lower legs;
 hoarseness











headache
diarrhea
nausea
gas
stomach pain
constipation
dry mouth
blisters or peeling skin hives
rash
itching
Aims
To compare efficacy and tolerability of five proton
pump inhibitors (PPIs) commonly used in the longterm therapy of GERD, namely omeprazole,
lansoprazole, rabeprazole, pantoprazole, and
esomeprazole;
To determine which PPI is more effective in
enduring symptom relief, improving quality of life as
well as in healing and preventing mucosal injury.
Study design

Synthesis studies: Metanalysis study

Bibliographic databases:
•
Medline (http://www.nlm.nih.gov/medlineplus/)
Pubmed (http://www.ncbi.nlm.nih.gov/sites/entrez)
Embase(http://www.elsevier.com/wps/find/bibliographicdataba
•
sedescription.cws_home/523328/description#description)
…
•
•
Ana Lopes
Andreia Pinto
Catarina Melo
Diogo Dias
Isabel Saavedra
João Matias
Mariana Ferreira
Mariana Mangas
Paula Neves
Rita Sapage
Rui Coelho
Teresa Caridade
Teresa Tavares
Turma 16
1º Ano
Disciplina de IntroMed I
FMUP
19 de Outubro de 2007