Gastroesophageal reflux disease (GERD) remains a challenging condition, even in the third millennium. For much of the past century, Schwartz's dictum-"No acid, no ulcer"-has shaped our approach to acid-related diseases, making acid suppression the cornerstone of therapy. Proton pump inhibitors (PPIs) are widely regarded as the standard treatment for GERD. However, they provide only symptomatic relief and do not address the underlying disease. Moreover, nearly 50% of patients experience limited or no response to PPIs in clinical practice. Recent advances in understanding GERD's pathophysiology, particularly the role of impaired mucosal integrity, have led to innovative therapeutic strategies. Among these, medical devices designed to prevent reflux or coat the esophageal mucosa and form a stable protective barrier represent a significant breakthrough. Esophageal mucosal protection is emerging as a promising approach, especially for patients who do not respond adequately to PPIs. While mucosal-protective agents such as sucralfate and irsogladine have long been available, their formulations have not been well-suited for esophageal protection. The rapid transit time of liquids through the esophagus (typically just a few seconds, even in a supine position) limits the duration of contact between active ingredients and the mucosa. However, hyaluronic acid and chondroitin sulfate-based medical devices have revolutionized the field by enabling active ingredients to adhere to the esophageal lining, ensuring prolonged contact and enhanced protection. Further advancements have led to the development of three distinct formulations (Esoxx™ One, Esoxx Defence, and Esoxx Protection), incorporating additional components, that is, Poloxamer 407, aluminum hydroxide, or natural remedies such as Aloe vera and honey. Each of these formulations offers unique physicochemical properties tailored to address both typical and atypical GERD symptoms. By leveraging the novel therapeutic approach of mucosal protection, these innovations aim to improve treatment outcomes and enhance patients' overall quality of life.
Keywords: GERD; LPR; NERD; PPIs; chondroitin sulphate; diagnosis; hyaluronic acid; medical devices; mucosal protection; treatment.
Medical devices with esophageal mucosal protective activity for the management of GERD Gastro-esophageal reflux disease (GERD), a condition where stomach acid or food flows back into the esophagus, is highly prevalent in the Western world and strongly impairs quality of life. It can cause symptoms like heartburn (a burning feeling in your chest), regurgitation (feeling like food is coming back up), and sometimes even coughing or a sore throat. GERD is still a tough condition to manage, even today. For many years, doctors have focused on reducing stomach acid to treat GERD, with proton pump inhibitors (PPIs) being the standard treatment. However, PPIs only help with the symptoms and don’t tackle the root cause of the disease. Additionally, about half of patients don’t experience enough relief from PPIs. New research into the causes of GERD has led to the development of new treatments, especially those designed to protect the lining of the esophagus. These treatments aim to prevent acid from damaging the esophagus or to create a protective barrier around it. Recently introduced medical devices containing hyaluronic acid (HA) and chondroitin sulfate (CS) that stick to the esophagus offer good protection of the esophageal mucosa, ultimately aiming to provide better results and a better quality of life for patients.
© The Author(s), 2025.