Proton pump inhibitors in the management of gastroesophageal reflux disease.

The primary treatment goals in patients with gastroesophageal reflux disease (GERD) are relief of symptoms, prevention of symptom relapse, healing of erosive esophagitis and prevention of complications. The severity of GERD is directly correlated with the degree and duration of oesophageal acid exposure and is highly pH dependent. Healing of reflux esophagitis is directly correlated with the intragastric pH > 3.5. In patients with GERD, treatment is directed at acid suppression through the use of lifestyle modifications (e.g., elevating the head of the bed, modifying the size and composition of meals) and pharmacologic agents (a histamine H2-receptor antagonist [H2RA] or a proton pump inhibitor [PPI]). The relief of symptoms and the long-term control of the disease are the primary aims of therapy for the majority of patients. The efficacy of antisecretory drugs in healing GERD depends on the strength and duration of acid suppression within a 24 h period, and the duration of the treatment. PPIs are more effective for acid-related symptoms and higher endoscopic healing rates in comparison with H2-RAs. Most PPIs (except pantoprazole) inhibit the bioactivation of clopidogrel to its active metabolite as they are associated with the loss of the beneficial effects of clopidogrel as well as an increased risk of reinfarction. Some clinicians reported their experiences that the generic has sometimes shown less effective than the corresponding branded PPIs. We conducted the overview of the effectiveness of PPIs in the treatment of patients with both categories of GERD; nonerosive reflux disease (NERD) and erosive reflux disease (ERD). We also report about interactions between PPIs and other drugs and differences between generic and branded PPIs.