| Abstract [eng] |
Aim of the work: to review and evaluate the role of prokinetic agents in the treatment of gastroesophageal reflux disease (GERD) by analysing their mechanisms of action, safety profile, and place in contemporary GERD management strategies. Objectives: 1) To describe the epidemiology, risk factors, clinical symptoms, and the physiological and pathological mechanisms of gastroesophageal reflux disease. 2) To review and describe GERD treatment strategies (excluding prokinetics), including lifestyle modification, antacids, alginates, H2 receptor antagonists, proton pump inhibitors, sucralfate, potassium-competitive acid blockers, and surgical treatment options. 3) To analyse and describe the significance of prokinetic agents in the treatment of GERD within contemporary management strategies. Methodology: a scientific literature review was conducted. For this review and analysis, publications were searched in the following databases: Medline (PubMed), Elsevier ClinicalKey and Google Scholar. During the search process, clinical studies published within the last 10 years were prioritized. However, when analyzing disease pathogenetic mechanisms, as well as drug pharmacokinetics and pharmacodynamics, no time restrictions were applied. The following English keywords were used: pathophysiology of GERD; GERD; antacids; alginates; sucralfate; potassium-competitive acid blockers; H2 receptor blockers; proton pump inhibitors; surgical treatment of GERD; prokinetics; role of prokinetics in the treatment of GERD. Inclusion criteria were articles published in English; full text scientific articles; narrative literature reviews; systematic reviews; clinical trials; systemic meta-analyses. Exclusion criteria were non-English publications; duplicate articles; articles without full text access; conference abstracts; letters to the editor. Full text articles were selected for final analysis if their title, abstract, or keywords met the inclusion criteria and were relevant to the selected topic. In total, 124 literature sources meeting the objectives of this review were analyzed. Conclusions: Gastroesophageal reflux disease is a multifactorial condition in which esophageal and gastric motility disorders, impairment of anti-reflux mechanisms and an imbalance between mucosal protective and aggressive factors play an important role in its pathogenesis. This disease is a current public health problem, affecting a significant part of the population worldwide. The different provocative factors and the significance of typical and atypical symptoms require a detailed approach to this pathological condition. The management of gastroesophageal reflux disease is complex. Lifestyle modification and elimination of risk factors are essential components. Proton pump inhibitors form the basis of pharmacological treatment, while the other drug classes (e.g., antacids, alginates) and surgical interventions are selected according to the specific clinical situation. Prokinetics play a significant role in the treatment of gastroesophageal reflux disease, as their mechanism of action is related to the improvement of gastrointestinal motility. This class of drugs is particularly beneficial in patients presenting with concomitant functional dyspepsia or gastrostasis symptoms. It is important to note that the use of prokinetics should be individualized, considering efficacy, comorbidities, and safety profile. |
