journal reading kelompok : management of gastroesophageal reflux disease

7/31/2019 Journal Reading Kelompok : Management of Gastroesophageal Reflux Disease

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MANAGEMENT OF

GASTROESOPHAGEAL REFLUX

DISEASE


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Introduction

Gastroesophageal reflux disease (GERD)

Abnormal reflux of gastroduodenal contents

Leads to variety of clinical symptomps quality of life


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Typical

symptoms

Atypical symproms Complications

Esophageal Extraesophageal

Esophageal Extraesophageal

Heartburn Dysphagia Epigastricpain

Esophagitis Dental injury

Regurgitation Odynophagia Dyspepsia Peptic ulcer Otitis media

Globus Bleeding PharyngitisEar pain Perforation Laryngitis

Hoarseness Stenosis Laryngealcancer

Chronic cough Brachyesopha

gus

Pneumonia

Asthma Barretscarcinoma

Interstitialfibrosis

Nocturnalsweats

Clinical manifestations of GERD


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A variety of approaches to the therapy of GERD havebeen suggested.

Majority of GERD patients, with or without esophagitis,require sustained acid suppression, which can beconsistently and safely achieved with proton pump

inhibitors (PPIs)

It is widely agreed that PPIs are the treatment of choice forGERD treatment, whether for short term or maintenancetherapy


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Atypical symptoms such as chronic cough,ear pain and hiccup can further confound thediagnosis of GERD

Once GERD is suspected, it is advisable tocarry out a single endoscopy to exclude anypossibility of Barretts esophagus.


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For patients who do not respond to standard

therapy, 24-h pH-metry is recommended in

difficult cases.

With these available methods and agood questionnaire to conduct a

thorough history, diagnosticsensitivity is approximately 90%


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Comparison of proton pump inhibitors

PPIs are the treatment of choice for GERD patients

In order to compare the effects of different PPI doses in

decreasing gastric acidity and increasing intergastric pH

above 3

99 patients with duodenal ulcer were administered either

omeprazole 10 mg, 20 mg or 40 mg o.d

After 4 weeks of treatment

Acid inhibition and ulcer healing

Dose dependent response :10 mg : 42% 20 mg: 79% 40 mg: 94%


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Another study

Pantoprazole 40 mg o.d VS OmeprazoleMultiple Unit Pellet System (MUPS) 40 mgo.d in GERD patients.

Have comparable healing rates. After 4 weeks treatment :

Pantoprazole : 78% Omeprazole : 76%

After 8 weeks treatment :Pantoprazole : 95% Omeprazole : 95%


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Another study

Pantoprazole 40 mg o.d >< Esomeprazole 40mg o.d in 227 patients with reflux esophagitis.

Clinical efficacy : Equivalent

The overall healing rates in the intentions to treat group were the same, andin per protocol groups there was a 5% greater response for pantoprazole.Similar results were also found for daytime and nighttime syndrom reductionwithin 4 weeks of treatment of the 40 mg dose of both drugs in 217 patientswith moderate to severe GERD.


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CHOOSING THE

APPROPIATE DOSE


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A higher PPI dose good results & costeffective in antypical GERD symptoms Severecase & extraesophageal manifestations.

3 placebo-controlled studies of PPIs (in astmatic

patient) omeprazole 40 mg b.i.d or q.i.d

improvement > 3 months of treatment(it longer than the standart treament 8weeks)


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Reduced dose of PPIs good results & costeffective.

Controlled trials

PPIs proven to be superiorto H2 receptor antagonist (H2RAs) both in

controlling symptoms and inducing healing ofmucosal lesions.*

*(low dose of PPIs >< high dose H2RAs)


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Pantoprazole20 mg o.d

Ranitidine150 mg b.i.d

Ranitidine300 mg b.i.d

Placebo

Clearly SuperiorPANTOPRAZOLE


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TOLERABILITY PROFILE

OF PPIS


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Interactions PPIs with metabolism of other

drugs different each other.

Pantoprazole not interfering with thecytochrome P450 system indicated in

patients with co-prescriptions of drugs that aremetabolized by these liver enzymes.

Pantoprazole no interactions with any otherdrugs preferable option GERD withcomorbidity & co-medication.


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CONCLUSION


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GERD & its clinical manifestations common

problems that bring large number of patients tophysicians everyday.

PPIsmainstay of the treatment of GERD withor without esophagitis.

PPIs save & cost effective both short &long treatment of GERD


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== EQUIPOTENCY ==

SHOWN

Omeprazole40 mg

Esomeprazole40 mg

Pantoprazole40 mg


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PANTOPRAZOLE

No Pharmacologicalinteractions with

any drugs

The choicetreatment for GERD

with comorbidity


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Thank Youfor Your Attention,

journal reading kelompok : management of gastroesophageal reflux disease

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