The use of prokinetic agents in GERD

Paul Moayyedi, MB, is a gastroenterologist and professor of medicine at McMaster University. He has served as director of the Division of Gastroenterology and president of the Canadian Association of Gastroenterology. He conducted large randomized controlled trials and observational studies in the areas of gastroesophageal reflux disease, Barrett esophagus, Helicobacter pylori, functional gastrointestinal disease, and inflammatory bowel diseases.

Should prokinetic agents be used in gastroesophageal reflux disease (GERD)? If so, in all or selected patients?

Paul Moayyedi, MB: Prokinetics have long been advocated as a treatment for GERD. This is because the underlying pathology is relaxation of the lower esophageal sphincter, so giving a prokinetic to strengthen this makes physiological sense.

However, used on their own, they’re not very effective in treating reflux disease. In all guidelines proton pump inhibitors (PPIs) are the first-line medical therapy for reflux disease. And if a PPI doesn’t work at all, it’s unlikely that adding a prokinetic will be helpful.

But there are few patients who have some residual symptoms and randomized trials do suggest that adding a prokinetic may benefit some individuals, but the effect is modest, so it’s really only for a select few patients with reflux symptoms who are getting an adequate response to PPIs.