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Article 17, 4/2016

ROMANIAN SNG* CORNER

Mucosal Protective Compounds in the Treatment of Gastroesophageal Reflux Disease. A Position Paper Based on Evidence of the Romanian Society of Neurogastroenterology

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Teodora Surdea-Blaga1, Ion Băncilă2, Daniela Dobru3, Vasile Drug4, Ovidiu Frățilă5, Adrian Goldiș6, Simona M. Grad1, Crina Mureșan1, Laurențiu Nedelcu7, Paul J. Porr8, Ioan Sporea6, Dan L. Dumitrașcu1

1) 2nd Medical Department, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca;
2) Fundeni Clinical Institute, Bucharest;
3) Gastroenterology Department, University of Medicine and Pharmacy, Târgu Mureș;
4) Institute of Gastroenterology and Hepatology, Grigore T. Popa University of Medicine and Pharmacy, Iasi;
5) Department of Internal Medicine, Emergency Clinical County Hospital, University of Oradea;
6) Gastroenterology and Hepatology Department, Victor Babeș University of Medicine and Pharmacy, Timișoara;
7) Faculty of Medicine, Transylvania University, Brașov;
8) Medical Department, County Emergency Hospital, Sibiu, Romania

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.254.dea

ABSTRACT
Background & Aims: Gastroesophageal reflux disease (GERD) therapy is challenging and suppression of acid secretion or prokinetics do not cure all cases. Some drugs with protective action on the esophageal mucosa have been used alternatively or in association with proton pump inhibitors (PPIs) and/or prokinetics. The Romanian Society of Neurogastroenterology undertook an Evidence-Based analysis, from which this position paper evolved.

Methods: We performed a systematic literature search in PubMed until October 2015, using the terms: sucralfate, guaiazulene, gaiazulene, dimethicone, alginate, antacids and gastroesophageal reflux. Forty-seven papers were included and analyzed. Several statements were elaborated regarding the use of these drugs in GERD. The evidence and recommendations were discussed between the authors.

Results: There is evidence in the medical literature suggesting the benefit of these drugs in GERD. In patients with persistent or mild reflux symptoms antacids rapidly relieve heartburn. Alginate-antacid combination is superior both over placebo and antacids to treat mild reflux symptoms, and can be used to treat persistent reflux symptoms despite acid suppressant therapy. Sucralfate is superior over placebo in alleviating GERD symptoms and can be used as maintenance therapy. Guaiazulene-dimethicone improves the quality of life in patients with GERD.

Conclusions: Drugs used to protect the esophageal mucosa against acid are useful in alleviating chronic heartburn, especially in patients with mild reflux symptoms.

Key words: gastroesophageal reflux disease – antacids– alginate– sucralfate – guaiazulene.

Abbreviations: CS: Chondroitin sulfate; DA: Double Action; EE : Erosive esophagitis ; GERD: Gastroesophageal reflux disease; HA: Hyaluronic acid; H2RA: Histamine 2 receptor antagonist; ITT: Intention to treat; IM: Irsogladine maleate; NERD: Non-erosive reflux disease; PPIs: Proton pump inhibitors; RCT: Randomized controlled trial; RDQ: Reflux disease questionnaire; QoL: Quality of life.