Managing gastroesophageal reflux disease: from pharmacology to the clinical arena

GERD is a condition affecting patients throughout the 24-hour period, although the nighttime interval may require special consideration because of the pharmacologic profile of the agents used to treat GERD, and the normal physiologic processes rendering nighttime GERD particularly damaging. GERD patients should be managed with appropriate therapy proportional to the frequency and severity of their symptoms. PPIs are the most potent inhibitors of acid secretion, and with a thorough knowledge of their pharmacologic properties, clinicians can be helped in identifying strategies that can maximize the benefits of their potency (see Table 2). PPIs offer significant benefit to persons requiring longer-term therapy because they are potent agents and offer ease of dosing and favorable drug interaction and adverse effect profiles. However, it is necessary that clinicians understand the physiology and pharmacology of acid secretion to use them appropriately. Inevitably, proper therapeutic treatment demands that variables such as pharmacokinetics, ethnicity (metabolic profile), and the normal physiology of acid secretion be considered when choosing an appropriate PPI.