IngentaConnect Review article: diagnosis and management of night-time reflux

Authors: McGuigan, J. E.¹; Belafsky, P. C.²; Fromer, L.³; McCarthy, D.⁴; Nostrant, T.⁵; Postma, G. N.⁶; Welage, L. S.⁷; Wolfe, M. M.⁸

Source: Alimentary Pharmacology & Therapeutics, Volume 20, Supplement 9, December 2004 , pp. 57-72(16)

Publisher: Blackwell Publishing

Abstract:

Summary

Symptoms of gastro-oesophageal reflux disease (GERD) range from mild to severe and, when they occur during night-time hours, can interfere with sleep patterns and reduce overall quality of life. The clinical presentation of GERD is characterized by oesophageal as well as supra-oesophageal symptoms, including otolaryngologic and pulmonary complications. However, GERD may be overlooked as the cause of a patient's supra-oesophageal symptoms because these complaints can occur in the absence of oesophageal symptoms or endoscopic changes. The role of available tools used for GERD diagnosis, including endoscopy, oesophageal pH monitoring and an empirical course of proton pump inhibitor therapy, is discussed. Interventions available to achieve the therapeutic goals of symptom relief and prevention include specific lifestyle modifications and over-the-counter as well as prescription pharmacological agents. Patient-initiated, as-needed treatment may not be the best choice for managing persistent night-time reflux because it requires patient arousal from sleep. Proton pump inhibitor therapy remains the treatment of choice for patients with more severe symptoms and those with erosive oesophagitis. Few studies have specifically evaluated the role of pharmacological agents in the management of night-time reflux and comparisons are difficult due to the variability in study design and endpoints assessed.

Document Type: Research article

DOI: 10.1111/j.1365-2036.2004.02241.x

Affiliations: 1: Division of Gastroenterology, University of Florida College of Medicine, Gainesville, FL 2: Department of Otolaryngology, University of California, Davis, Sacramento, CA 3: Department of Family Medicine, School of Medicine, University of California, Los Angeles, Santa Monica, CA 4: Division of Gastroenterology & Hepatology, University of New Mexico & V. A. Medical Center, Albuquerque, NM 5: Department of Gastroenterology, University of Michigan, Ann Arbor, MI 6: Center for Voice & Swallowing Disorders, Department of Otolaryngology, Wake Forest University School of Medicine, Winston-Salem, NC 7: Department of Clinical Sciences, University of Michigan College of Pharmacy, Ann Arbor, MI 8: Section of Gastroenterology, Boston University School of Medicine, Boston, MA, USA

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