Mucosal Protective Compounds in the Treatment of Gastroesophageal Reflux Disease. A Position Paper Based on Evidence of the Romanian Society of Neurogastroenterology.

BACKGROUND AND AIMS: Gastroesophageal reflux disease (GERD) therapy is challenging and suppression of acid secretion or prokinetics do not cure all cases. Some drugs with protective action on the esophageal mucosa have been used alternatively or in association with proton pump inhibitors (PPIs) and/or prokinetics. The Romanian Society of Neurogastroenterology undertook an Evidence-Based analysis, from which this position paper evolved. METHODS: We performed a systematic literature search in PubMed until October 2015, using the terms: sucralfate, guaiazulene, gaiazulene, dimethicone, alginate, antacids and gastroesophageal reflux. Forty-seven papers were included and analyzed. Several statements were elaborated regarding the use of these drugs in GERD. The evidence and recommendations were discussed between the authors. RESULTS: There is evidence in the medical literature suggesting the benefit of these drugs in GERD. In patients with persistent or mild reflux symptoms antacids rapidly relieve heartburn. Alginate-antacid combination is superior both over placebo and antacids to treat mild reflux symptoms, and can be used to treat persistent reflux symptoms despite acid suppressant therapy. Sucralfate is superior over placebo in alleviating GERD symptoms and can be used as maintenance therapy. Guaiazulene-dimethicone improves the quality of life in patients with GERD. CONCLUSIONS: Drugs used to protect the esophageal mucosa against acid are useful in alleviating chronic heartburn, especially in patients with mild reflux symptoms.

Post-cholecystectomy syndrome and magnesium deficiency.

BACKGROUND AND OBJECTIVE: In 20%-30% of cholecystectomised patients a biliary syndrome (called Post-Cholecystectomy Syndrome: PCES) reappears after some weeks or months. Its etiology, in certain cases, is an anatomic one: (choledochal lithiasis or stricture, obstructive papillitis, pancreatic duct stenosis), but there are many cases in which all organic causes are excluded. METHODS: The aim of this study was to analyze the correlation between these functional disturbances and magnesium (Mg) deficiency (MD). We analysed 52 patients with PCES and MD, in which organic lesions of the remaining bile ducts were excluded by imaging and endoscopic methods. RESULTS: MD was confirmed by serum and erythrocytic low Mg levels. 82% of patients were women. Supplemental therapy was provided with Tiomag (Mg gluconate and methionine), vitamin B6 and Ca lactate for 6 weeks or more. In 50 patients, PCES symptomatology disappeared after this treatment. In 14 cases some symptoms reappeared after a few weeks-months, but after repetition of the same therapy they completely disappeared. CONCLUSIONS: Our results demonstrate the dependence of PCES functional manifestations on MD, especially the recurrence of symptoms, which again subsided after Tiomag therapy was reinstituted.