Background: Gastroesophageal reflux disease (GERD) remains one of the most prevalent gastrointestinal disorders worldwide. Between 2015 and 2025, advances in understanding its multifactorial pathophysiology have driven significant changes in pharmacological management. Aim: This review summarizes key developments in GERD pathophysiology and evaluates significant pharmacological advances from 2015 to 2025, including comparative safety profiles, limitations of current therapies, and emerging treatment directions. Methods: A structured search of PubMed, Google Scholar, and major open-access databases was performed using keywords related to GERD, pathophysiology, proton pump inhibitors, P-CABs, prokinetics, neuromodulators, and novel therapies. Results: Proton pump inhibitors remain first-line therapy but show variable efficacy in non-erosive disease and refractory symptoms. Newer agents such as potassium-competitive acid blockers, modern prokinetics, alginate-based formulations, neuromodulators, and mucosal protectants offer therapeutic benefits in selected phenotypes. Comparative analyses highlight the importance of optimizing long-term PPI use and monitoring potential adverse effects. Advances in diagnostics and improved understanding of sensory and functional mechanisms have enabled more individualized treatment strategies. Conclusions: Pharmacological management of GERD has evolved substantially over the past decade, shifting toward mechanism-based and patient-specific therapy. Future progress will depend on integrating high-resolution diagnostics, refining reflux phenotypes, and developing novel treatments that target mucosal integrity, hypersensitivity, and non-acid reflux.

A review of current and potential applications of macroalgae to equine veterinary science.

Co-fermentation of honeysuckle-Cassia seeds by Lactobacillus acidophilus and Bacillus subtilis: A new approach to attenuate alcohol-induced acute gastric mucosal damage and modulate immune response.

Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder, characterized by the retrograde flow of gastric contents into the esophagus, causing symptoms such as heartburn and regurgitation. Although many patients with symptomatic GERD show no visible mucosal injury, impairment of its integrity at microscopic level is considered a relevant factor contributing to symptom generation and inflammation. In this scenario, protection of esophageal mucosa by topical agents has become a potential therapeutic approach. We investigated the protective and regenerative effects of a new natural formulation (GSE Reflusolve Rapid), using a dynamic culture based on MIVO® esophagus-on-chip platform, compared to an alginate/carbonate-based product. Results demonstrate that both products preserved esophageal integrity following acid stimulation, mitigating transepithelial electrical resistance (TEER) decline and upregulating MUC5B expression. Moreover, the natural formulation showed a significant reduction in IL-8 levels (p < 0.05) in contrast to the alginate-based formulation, despite the lack of a buffer action. TEER measurement, FITC-dextran permeability assay and histological analysis showed also the reparative properties of both mucosal protectants after acidic insult. In particular, the natural formulation showed a more pronounced and uniform expression of MUC5B throughout the tissue. These findings highlight that GSE Reflusolve Rapid may be a valid alternative to control long-term GERD-symptoms.

Italian guidelines for the diagnosis and treatment of functional dyspepsia - joint consensus from the Italian societies of gastroenterology and endoscopy (SIGE), Neurogastroenterology and motility (SINGEM), hospital gastroenterologists and endoscopists (AIGO), digestive endoscopy (SIED) and general medicine (SIMG).

Rebamipide is a gastric mucosal protectant used to relieve gastritis symptoms. Real-world evidence on the comparative effectiveness of rebamipide monotherapy versus combination therapy with proton-pump inhibitors (PPIs) in routine clinical settings is limited. This study evaluated the effect of rebamipide in reducing subjective gastrointestinal (GI) symptoms among patients with gastritis symptoms using a patient-focused approach. This multicenter, observational study enrolled patients aged 19 years and older who were prescribed rebamipide for gastritis symptoms across 81 local clinics and hospitals. Patients received rebamipide twice daily for 2 weeks, with an optional 4-week extension. GI symptom severity and frequency were collected via patient-reported outcomes at baseline and posttreatment. Patients were categorized into a rebamipide monotherapy group and a combination therapy group, with inverse probability of treatment weighting (IPTW) applied to adjust for baseline confounding. Statistical analyses included ANCOVA for symptom score changes and chi-square tests for categorical symptom improvement. Of the 2209 patients included in the analysis, 1946 were in the monotherapy and 263 were in the combination therapy. Both treatment groups showed significant posttreatment reductions in GI symptom scores, and there was no significant difference between the two groups in severity, frequency, and total score before and after IPTW (p > 0.05). The symptom improvement rate (≥ 50% reduction) was 71.5% in the monotherapy group and 71.4% in the combination therapy group, with no significant difference between the two groups (p = 0.976). Rebamipide monotherapy provided similar levels of GI symptom relief compared to combination therapy with PPIs in a real-world clinical setting.

Background: Warm-e-Meda, a well-recognized disease in the Unani system of medicine, corresponds closely to gastritis in modern medicine. It is primarily attributed to an imbalance in humoral temperaments, especially the predominance of Safrā (yellow bile) and excessive Harārat (heat) in the stomach. The Unani scholars, including Ibn Sina, Razi, and Jurjani, provided detailed descriptions of its causes, types, and treatment centuries before the modern understanding of gastric inflammation emerged. Objective: This paper aims to critically review the concept of Warm-e-Meda through the lens of classical Unani texts and juxtapose it with modern medical understanding of gastritis. It emphasizes the etiology, pathophysiology, clinical features, diagnostic approaches, and treatment strategies in both systems. Methods: A qualitative review was conducted using primary Unani sources such as Al-Qanoon fit Tib, Zakhira Khwarizm Shahi, Kitab al-Hawi, and contemporary Unani pharmacopeias. Modern references include textbooks like Robbins Basic Pathology, Yamada’s Gastroenterology, and peer-reviewed clinical guidelines. A comparative evaluation was performed to highlight similarities and differences in diagnosis and treatment. Results: Unani medicine classifies Warm-e-Meda into several subtypes based on the dominant morbid humor (Safrā, Sauda, Balgham) and emphasizes personalized treatment involving Ilāj bil Ghizā (diet therapy), Ilāj bid Dawa (herbal drugs), and Ilāj bit Tadbeer (regimenal therapies). In contrast, modern medicine focuses on pharmacologic management using proton pump inhibitors, H. pylori eradication regimens, and mucosal protectants. Both systems acknowledge dietary and psychological triggers. However, the Unani approach incorporates temperament-based diagnosis and holistic healing, often avoiding the adverse effects associated with modern pharmacotherapy. Conclusion: Warm-e-Meda reflects a deep-rooted understanding of gastric pathology within the Unani framework.

Background: Endoscopic variceal band ligation (EVBL) is an established therapy for esophageal variceal hemorrhage but is frequently associated with post-procedural complications including esophageal ulceration, dysphagia, retrosternal pain, and rebleeding. While proton pump inhibitors (PPIs) are commonly administered post-EVBL to promote ulcer healing, residual symptom burden and rebleeding risk remain, and the potential additive benefit of sucralfate as a mucosal protectant is uncertain. Objective: To compare symptoms and risk of rebleeding in patients receiving PPI with sucralfate versus PPI alone following EVBL. Methods: A randomized controlled trial was conducted at a tertiary care hospital over six months. Seventy-two patients undergoing EVBL were randomized 1:1 to receive PPI plus sucralfate or PPI alone. Patients were followed for two weeks for assessment of post-ligation symptoms, endoscopic ulcer occurrence, and rebleeding. Statistical analyses included independent sample t-tests and chi-square tests, with logistic regression used to adjust for confounders. Results: The PPI plus sucralfate group experienced significantly lower rates of retrosternal pain (13.9% vs 36.1%, p=0.037), dysphagia (8.3% vs 27.8%, p=0.041), ulcer formation (16.7% vs 41.7%, p=0.018), and rebleeding (5.6% vs 22.2%, p=0.042) compared to PPI alone. Conclusion: Adjunctive sucralfate significantly improves post-EVBL symptom control, reduces ulcer formation, and lowers rebleeding risk, supporting its use in routine post-ligation management.

Daidzein alleviates ethanol-induced acute gastric injury in rats by targeting ESR1 and activating the PI3K/AKT/CREB signaling pathway.

ObjectiveThis study aimed to investigate the factors associated with severe radiation-induced oral mucositis (SRIOM) in nasopharyngeal carcinoma (NPC) patients undergoing chemoradiotherapy (CRT) and to establish a prediction model for SRIOM.MethodsA total of 262 NPC patients who underwent CRT were analyzed retrospectively, including 192 in the modeling group and 70 in the validation group. The modeling group was divided into the non-SRIOM group (n = 112) and the SRIOM group (n = 80), and the validation group was divided into the non-SRIOM group (n = 40) and the SRIOM group (n = 30) according to the presence of SRIOM. Univariate and multivariate logistic logistic analyses were performed on the clinical data and general characteristics of all patients to construct a prediction model for SRIOM in NPC patients. The practical efficacy of the prediction model was evaluated using Hosmer–Lemeshow test, receiver operating characteristic curve (ROC), and decision curve analysis (DCA).ResultsBMI < 23.9 kg/m2, history of periodontal disease, history of alcohol consumption, history of smoking, non-use of oral mucosal protectants, and poor oral hygiene were independent risk factors for SRIOM in NPC patients. The prediction model showed an area under the ROC curve of 0.813 (95% CI 0.752–0.875). The prediction model demonstrated strong predictive accuracy and clinical utility, as evidenced by both calibration and DCA curves.ConclusionThe SRIOM prediction model, developed from the clinical characteristics and general information of NPC patients, is beneficial in clinical practice for identifying high-risk SRIOM and creating tailored treatment plans.

Among the various factors implicated in the pathogenesis of gastroesophageal reflux disease (GERD), visceral hypersensitivity and mucosal resistance have been recently re-evaluated in relation to the increasing phenomenon of proton pump inhibitor failure, particularly in patients with nonerosive reflux disease (NERD). Intensive research has allowed us to understand that noxious substances contained in the refluxate are able to interact with esophageal epithelium and to induce the elicitation of symptoms. The frequent evidence of microscopic esophagitis able to increase the permeability of the mucosa, the proximity of sensory afferent nerve fibers to the esophageal lumen favoring the higher sensitivity to noxious substances and the possible activation of inflammatory pathways interacting with sensory nerve endings are pathophysiological alterations confirming that mucosal resistance is impaired in GERD patients. Accordingly, the reinforcement of protective mechanisms of esophageal mucosa by topical therapies has become a novel treatment target. Alginate, the combination of hyaluronic acid+chondroitin sulphate and Poliprotect have been shown to adhere to esophageal mucosa and to have good protective properties. Several placebo-controlled clinical trials have shown that these compounds, given alone or as add-on therapy for short periods, enable to relieve symptoms and to improve the quality of life in NERD patients. Further studies are needed to confirm the above results and to find new mucosal protectants in order to improve the management of NERD patients.

Laryngopharyngeal reflux (LPR) is defined as an extraesophageal reflux of gastroduodenal contents to the laryngopharynx, affecting the upper aerodigestive tract. There is currently no standardized treatment protocol for LPR. The use of proton pump inhibitors (PPIs) is widely established in common practice and derives from the standard approach of using PPIs to treat patients with gastroesophageal reflux disease (GERD). However, as PPIs may not be effective on all types of reflux, the aim of our study was to evaluate the effectiveness of dietary changes and mucosal protectants, alone or in combination, in LPR treatment. This multicenter randomized controlled trial included 48 patients divided into three groups: dietary modifications only, mucosal protectors only, and a combination of both. The patients' responses were assessed over 1 month using the Reflux Symptom Index (RSI) and Reflux Finding Score (RFS), along with measurements of salivary and nasal pepsin concentration and rhinomanometry. Significant improvements were observed in RSI and RFS scores across all groups. The group receiving combined dietary modifications and mucosal protectors showed the most substantial benefits. Additionally, a notable reduction in salivary and nasal pepsin concentrations and nasal resistances was observed, particularly in patients combining dietary modifications and mucosal protectors. The study showed that combined dietary modifications and mucosal protects strategies effectively manage LPR symptoms, offering a potential therapeutic approach.

Type 2 diabetes (T2D) is an important risk factor for brain cognitive impairment, but the specific mechanism is still unclear. The imbalance of gut microbiota under pathological conditions (such as an increase in pathogenic bacteria) may be involved in the occurrence of various diseases. The purpose of this study is to investigate the effect of increased abundance of gut Citrobacter rodentium on cognitive function in T2D mice. Our results indicate that an increase in the abundance of Citrobacter rodentium leads to impaired intestinal barrier, elevated expression of inflammatory factors in blood and brain tissue, and promotes cognitive impairment in T2D mice. The specific pathway involves activation of farnesol X receptor (FXR) expression-mediated intestinal barrier dysfunction. The use of intestinal mucosal protectants and FXR inhibitors improved intestinal barrier function and brain cognitive function. Therefore, the research results provide a mechanistic link between the increased abundance of Citrobacter in the gut of T2D mice and brain cognitive function, and provide a reference for the occurrence of brain cognitive dysfunction in T2D.

Gastric ulcer is a significant clinical issue in dogs, with higher prevalence in mature animals and often occurs secondary to systemic diseases such as hepatic or renal disorders, Addison’s disease or shock. This case report highlights a four-and-a-half-year-old intact male Rottweiler presented with persistent vomiting, anorexia, abdominal pain and anemia. Diagnostic imaging, including radiography, ultrasonography and endoscopy, revealed gastric ulceration and the presence of radiopaque lead pellets in the pyloric region of the stomach. Histopathological examination confirmed extensive gastric mucosal damage.Treatment included the elimination of lead, fluid therapy and administration of proton pump inhibitors, antibiotics and mucosal protectants. Incorporating psyllium husk into the diet helped to enhance lead excretion. Follow-up imaging after two weeks showed absence of lead pellets and normal gastric mucosa. This case underscores the importance of comprehensive diagnostic and therapeutic approaches for chronic gastric ulcers in dogs, emphasising the role of multimodal imaging and targeted treatment strategies. Keywords: Dog, gastric ulcers, diagnostics, therapeutics

Analysis of factors related to radiation-induced oral mucositis in patients with head and neck tumors undergoing radiotherapy

BackgroundPreventing the progression of chronic oral graft-versus-host disease (cGVHD) is essential for maintaining oral health, improving quality of life, minimizing functional impairment, reducing systemic complications, and addressing treatment challenges.PurposeTo evaluate the effectiveness of early intervention with oral mucosal barrier protective agents in preventing the progression of cGVHD and its impact on oral health, quality of life, and treatment response.MethodsThis retrospective cohort study included 75 participants, with 34 in the non-oral mucosal barrier protective agent group and 41 in the oral mucosal barrier protective agent group. Baseline characteristics, oral mucosal health parameters, quality of life assessments, and curative effect data were collected and compared between the two study groups.ResultsThe group receiving oral mucosal barrier protectants (n = 41) exhibited significantly lower severity of oral mucositis compared to the group without such protectants (n = 34) (2.12 ± 0.48 vs. 2.56 ± 0.63, P = 0.001) and the incidence of complications was significantly lower in the group receiving oral mucosal barrier protectants (P < 0.05). Additionally, the quality of life assessment showed marked improvements in somatization, emotional management, and social reintegration in the oral mucosal barrier protectant group compared to the group without these protectants (P < 0.05). Furthermore, the assessment of treatment efficacy revealed significantly higher rates of both complete and partial responses in the oral mucosal barrier protectant group, along with a notable reduction in disease progression compared to the group without these protectants (P < 0.001).ConclusionEarly intervention with oral mucosal barrier protective agents was associated with improved oral health parameters, enhanced quality of life, and a more favorable treatment response in the context of cGVHD.

Bioadhesive chitosan hydrogel with ROS scavenging promotes angiogenesis and mucosal repair for the treatment of gastric ulcer

This study aimed to investigate the trends in diseases of the digestive system hospital admissions (DDSHA) in England and Wales between (1999–2019). Secondary objectives were to investigate the type of admission and medication prescribing related to the digestive system in England. This is an ecological study using data from the Hospital Episode Statistics (HES) database and the Patient Episode Database between April 1999 and March 2019. The rate of hospital admissions with 95% confidence intervals (CIs) was calculated by dividing the number of DDSHA by the mid-year population. The trend in hospital admissions was assessed using a Poisson model. Overall, the rate of DDSHA rose by 84.2% (from 2231.27 [95% CI 2227.26–2235.28] in 1999 to 4109.33 [95% CI 4104.29–4114.38] in 2019 per 100,000 persons, trend test, P < .001). The most remarkable rise in hospital admission was seen in liver diseases, followed by other diseases of intestines with 1.85-fold, and 1.59-fold, respectively. Between 2004 and 2019, the overall prescribing rate for medications related to the gastrointestinal system increased by 74.6%, and stoma care related medications prescribing rate increased by 2.25-fold, followed by drugs affecting intestinal secretions and antisecretory drugs and mucosal protectants. There was an increase in hospital admission rate due to GI diseases in the United Kingdom (UK) by 84.2% from 1999 to 2019. The most remarkable rise in the rate of hospital admissions was seen in diseases of the liver and intestine.

IntroductionFormularies of essential medicines, such as Essential Medicines Lists (EMLs) and health emergency stockpiles, are intended to be always available, including in emergency situations, acting as important tools for access to medicines. The Emergency Medicines Buffer Stock (EMBS) in the United Kingdom (UK) was a stockpile of critical medicines managed by the UK Department of Health and Social Care (DHSC). We propose a new methodology for selecting and including medicines in EMLs and health emergency stockpiles and empirically apply it for selecting medicines in the case of the UK EMBS. MethodsWe used Multi-Attribute Value Theory and Portfolio Decision Analysis to develop a three-phase methodological framework for medicines selection, involving: (i) the decision context definition and selection of evaluation criteria, (ii) the therapeutic area prioritisation, and (iii) the medicines value-for-money evaluation and product selection. The EMBS application took place in 2018–2019 and focused on therapeutic area prioritisation, involving primary data collection through expert interviews (n = 4), a workshop with DHSC decision-makers (n = 13), and an online survey with National Clinical Directors and relevant experts (n = 24). A Monte Carlo simulation supported therapeutic area prioritisation using the British National Formulary (BNF) classification. FindingsTwo criteria sets were selected for i) therapeutic area prioritisation, reflecting the value concerns of population need and shortage severity, and ii) medicines evaluation, reflecting magnitude of clinical benefit and supply vulnerability, among others.Primary evidence was collected for “national need” and “shortage severity”, based on which a “population health loss” index was developed. A total of 51 therapeutic areas were ranked using their index value while assessing the robustness of the ranking. The top ranked therapeutic area was antisecretory drugs and mucosal protectants, closely followed by diabetes drugs. ConclusionsThe methodological application generated a ranking of therapeutic areas based on expected “population health loss” index, while addressing evidence uncertainty. The methodology can be adapted for other EMLs and emergency stockpile contexts to inform medicines selection.

Gastroesophageal Reflux Disease (GERD) is a chronic ailment that results from the backward flow of stomach acid into the esophagus, causing heartburn and acid regurgitation. This review explores nanotechnology as a novel treatment approach for GERD. Chitosan nanoparticles (CSNPs) offer several advantages, including biocompatibility, biodegradability, and targeted drug delivery capabilities. CSNPs have been extensively studied due to their ability to encapsulate and release medications in a controlled manner. Different nanoparticle (NP) delivery systems, including gels, microspheres, and coatings, have been developed to enhance drug retention, drug targeting, and controlled release in the esophagus. These nanoparticles can target specific molecular pathways associated with acid regulation, esophageal tissue protection, and inflammation modulation. However, the optimization of nanoparticle formulations faces challenges, including ensuring stability, scalability, and regulatory compliance. The future may see CSNPs combined with other treatments like proton pump inhibitors (PPIs) or mucosal protectants for a synergistic therapeutic approach. Thus, CSNPs provide exciting opportunities for novel GERD treatment strategies.