Pharmacological management of gastro-esophageal reflux disease: state of the art in 2024.

Gastroesophagealreflux disease (GERD) is a chronic disease of the esophagus characterized bythe regurgitation of stomach contents into the esophagus causing troublesomesymptoms and/or complications. Among patients with GERD, around 30% of patientshave visible mucosal damage, while 70% have a normal esophageal mucosa. Accordingly,the optimal pharmacological treatment of GERD should address different diseasemanifestations, including symptoms, the mucosal damage when present, and possiblechronic complications, including strictures, Barrett's esophagus, andesophageal adenocarcinoma. Available medicaltreatments for GERD include proton pump inhibitors (PPIs),potassium-competitive acid blockers (PCABs), histamine receptor antagonists (H2-RAs),prokinetics, and mucosal protectants such as alginates, hyaluronicacid/chondroitin-sulfate, and poliprotect. Each compound has its ownadvantages and disadvantages, and knowledge of expected benefits and tips fortheir use are paramount for the success of treatment. In addition, theappropriateness of indications for initiating treatment is also crucial toachieve positive results when managing GERD patients. PPIs,PCABs, H2-RAs, prokinetics, and mucosal protectants can all be used in patientswith GERD, but careful assessment of patients' characteristics as well asadvantages and disadvantages of each therapeutic compound is essential toensure successful treatment of GERD.