GERD quadrotherapy: a new method to an old problem

GERD quadrotherapy: a new method to an old problem

S.N. Mekhtiev^1,2, O.A. Mekhtieva^1,2, O.M. Berko² 

¹Pavlov First Saint-Petersburg State Medical University, St. Petersburg

²Gastroenterology Center Expert LLC, St. Petersburg 

It is known that the standard treatment of gastroesophageal reflux disease (GERD), consisting in taking proton pump inhibitors (PPIs), is commonly not effective enough both in achieving clinical and/or endoscopic remission and in preventing subsequent exacerbations. The article discusses a variant of the pathogenetically optimal treatment regimen for patients with newly diagnosed GERD, given the cases of possible refractoriness to standard PPI monotherapy. The regimen includes rabeprazole, rebamipid, trimebutin and ursodeoxycholic acid (UDCA). Rabeprazole has the greatest acid suppressive ability compared to other PPIs. Results of numerous studies have shown its efficacy and safety, including during long-term administration. The addition of rebamipid to PPIs in the treatment of GERD allows to achieve better control of reflux symptoms and more effectively prevent their recurrence, and also has an oncoprophylactic effect. A prokinetic agent inclusion in the GERD therapy regimen, for example, trimebutin, increases the therapy efficacy. The basis for the use of UDCA is the presence of its cytoprotective effect, which allows to achieve reduction of clinical symptoms and endoscopic signs of damage to the mucous membranes. The proposed quadrotherapy regimen can also be used in the case of refractory GERD.

Keywords: proton pump inhibitor, gastroesophageal reflux disease, duodenogastroesophageal reflux, non-erosive reflux disease, rabeprazole, rebamipid, trimebutin, ursodeoxycholic acid, quadrotherapy.

For citation: Mekhtiev S.N., Mekhtieva O.A., Berko O.M. GERD quadrotherapy: a new method to an old problem. RMJ. 2023;2:83–87.