| |NOVEMBER 20238CIOReviewIN MY OPINIONEsophagitis, gastritis, and gastro-duodenal ulcers are pathologies that impact a high proportion of the population, significantly affecting patients' quality of life. Of these, non-erosive esophagitis is the most prevalent and represents a diagnosis challenge for physicians. If, when performing the upper endoscopy, the specialist does not find macroscopic erosion or histological inflammation, pHmetry, and esophageal impedance studies should be carried out. The first one records pH levels and time of acid exposure in the esophageal mucosa and the second one identifies potentially harmful non-acid regurgitation. Early diagnosis and adequate treatment of this pathology prevent progression to erosive esophagitis, Barrett's esophagus, and esophageal cancer, in addition to improving patients' quality of life. Since the ´90s, the gold standard treatment for these acid-related diseases has been proton pump inhibitors (PPIs). The parietal cells of the gastric mucosa contain these energy-dependent pumps that excrete hydrogen (acid) into the lumen of the stomach, exchanging them for a potassium ion (K+). Doctors indicate this treatment for a month and call the patient for control, describing that 20 to 40 percent of them do not respond satisfactorily to the therapy (Fass R 2005). Most patients report feeling better but 85 percent describe symptoms persistence, even while receiving medication (Chey W 2009). This entails a high cost for the family and health payers because the doctors are forced to carry out other paraclinical studies to decline diverse causes of the symptoms. The main reasons for the persistence of symptoms despite being esophagitis associated with gastric acid are that PPIs are administered as pro-drugs (they must be metabolized to achieve their therapeutic effect), and they have a late onset of action and short half-life time. They need to be By Carlos Alberto Reyes M, MD EdD, Medical Affairs Lead, Carnot Laboratorios ANALYZING GASTRIC ACID-RELATED DISEASESCarlos Alberto Reyes
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