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Volume 5, Supplement 2, 2005

Volume 5, Supplement 2, 2005

Table of Contents

Gastroesophageal Reflux Disease and Sleep Disorders: A Wake-Up Call for Physicians and Their Patients Compliance With GERD Therapy
Sleep’s implications to the physiology and pathogenesis of a number of diseases have been ignored until recently. With the evolution of studies conducted in sleep laboratories, the relationship between various gastrointestinal diseases, in particular gastroesophageal reflux disease (GERD), and sleep disorders is being recognized. This article discusses the personal and societal impact of GERD-related sleep disorders, including quality of life issues and work and leisure impairment. A review of intervention studies indicates that GERD-related sleep disorders respond effectively to acidsuppressive medical therapy. Clinicians are advised to take a proactive stance in evaluating patients with GERD for unrecognized sleep disorders and ascertaining whether patients with sleep disorders have GERD symptoms as well. [Rev Gastroenterol Disord. 2005;5(suppl 2):S3-S11]
Increasing Compliance With Long-Term Therapy: Avoiding Complications and Adverse Events Compliance With GERD Therapy
Compliance with long-term therapy is an important consideration in any chronic disease. Patients with gastroesophageal reflux disease (GERD) frequently stop and start treatment based on their symptoms. This form of therapy (“on-demand treatment”) has been shown to be effective in patients with non-erosive reflux disease and may reduce the costs associated with long-term therapy. However, continuous medical therapy for erosive esophagitis is associated with fewer relapses and better outcomes. Similarly, long-term therapy administered continuously reduces complications such as stricture and may decrease the development of dysplasia in Barrett’s esophagus. [Rev Gastroenterol Disord. 2005;5(suppl 2):S12-S17]
Intravenous Proton Pump Inhibitor Therapy: A Rationale for Use Compliance With GERD Therapy
Proton pump inhibitors (PPIs) are used widely in the management of acidrelated disorders and, for the majority of patients, oral therapy is highly effective. Not all patients with acid-related disorders respond completely to standard, once-daily PPI therapy, but most nonresponders will generally respond to an increase in the dose or frequency of PPI therapy. At equivalent doses, oral and intravenous (IV) PPIs produce comparable acid suppression; thus there are very few clinical indications for IV PPI therapy. IV PPIs are an appropriate substitute for oral PPIs, at an equivalent dose, for patients with, for example, gastroesophageal reflux disease, peptic ulceration, or Zollinger-Ellison syndrome, who cannot take oral medication. For patients with nonvariceal, upper gastrointestinal hemorrhage, profound acid suppression (gastric pH  6.0) optimizes clot stability and reduces the risk of rebleeding; this is achieved most effectively with an initial IV PPI bolus followed by a continuous infusion. High-dose, IV PPI therapy is beneficial and cost-effective in patients who have a high-risk lesion at endoscopy and it should be preceded by effective endoscopic hemostasis if possible. IV PPIs, preoperatively and in the intensive care setting, effectively reduce gastric acidity, but there are no convincing data that this confers any significant clinical benefit compared with other therapeutic strategies. [Rev Gastroenterol Disord. 2005;5(suppl 2):S18-S30]
Gastroesophageal Reflux Disease and Extraesophageal Disease Compliance With GERD Therapy
The patient with extraesophageal manifestations of gastroesophageal reflux disease presents a clinical challenge. Symptom presentation overlaps with other otolaryngologic and pulmonary disease, and heartburn might be infrequent or absent. Endoscopy and pH monitoring are insensitive and therefore not useful in many patients as diagnostic modalities. Thus, antisecretory therapy is used as both a diagnostic trial and as therapy in the majority. Attention to optimizing therapy and judicious use of endoscopy and reflux monitoring are needed to minimize cost and maximize success. [Rev Gastroenterol Disord. 2005;5(suppl 2):S31-S38]
Nonsteroidal Anti-Inflammatory Drugs, Aspirin, and Gastrointestinal Prophylaxis: An Ounce of Prevention Compliance With GERD Therapy
Because of the widespread use of nonsteroidal anti-inflammatory drugs (NSAIDs), NSAID-related gastrointestinal (GI) complications are recognized as the most prevalent drug toxicity in the United States. The withdrawal of 2 selective cyclooxygenase-2 (COX-2) inhibitors (agents specifically developed to reduce ulcer complications) from the US market owing to adverse cardiovascular events has made reducing ulcer risk more important than ever for patients receiving NSAID treatment. In addition, the impact of aspirin, implicated by itself as a cause of serious adverse GI events and in combination with NSAIDs as a source of incremental risk, remains under-appreciated. Balancing the cardiovascular risks of selective COX-2 inhibitors with the higher GI risks associated with conventional NSAIDs remains a major clinical challenge. Gastroprotective therapy, such as with a proton pump inhibitor, is beneficial in patients receiving NSAIDs, but despite current treatment recommendations, this “ounce of prevention” remains substantially underused for patients at risk. [Rev Gastroenterol Disord. 2005;5(suppl 2):S39-S49]