Noncompliance is an impact factor in the treatment of gastroesophageal reflux disease

Abstract

The basis of pharmacological treatment of the gastroesophageal reflux disease is the use of proton pump inhibitors (PPIs) which provide effective gastric acid secretion blockade. However, PPI therapy failure may occur in up to 42% of patients. The main causes for therapeutic failure are non-acid or weakly acid reflux, genotypic differences, presence of comorbidities, wrong diagnosis and lack of treatment compliance. Noncompliance is an important issue and should be carefully observed. Several studies addressed patient compliance and 20–50% of patients may present lack of compliance to the PPI prescribed. When symptoms persist depite adherence has been confirmed, it is recommended to substitute the prescribed PPI to another of the same class or alternatively, prescription of a double dose of the same drug. When even so the symptoms persist, other causes of failure should be assigned. In particular cases of PPI failure, fundoplication surgery may be indicated.

Keywords::

• adherence
• compliance
• gastroesophageal reflux disease
• GERD treatment
• proton pump inhibitors

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Acid suppression by proton pump inhibitors (PPIs) is the cornerstone of gastroesophageal reflux disease (GERD) pharmacological treatment. The PPIs currently available are omeprazole, pantoprazole, rabeprazole, lansoprazole and esomeprazole.

• Although the PPIs provide effective gastric acid secretion blockade when prescribed at standard doses and administered in the morning, therapy failure may occur: 20–42% of the cases may not respond to PPI therapy.

• There several causes for the lack of PPI response: functional heartburn, inadequate PPI dosage, wrong GERD diagnosis, presence of comorbidities, nonacid gastroesophageal reflux, autoimmune skin diseases, eosinophilic esophagitis and nonadherence.

• Nonadherence may be influenced by social and demographic factors, financial pressures, poor understanding, adverse events to medications, etc.

• In patients with PPI therapeutic failure, the compliance should be initially assessed. When the adherence is considered satisfactory, other factors should be addressed.