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Proton pump inhibitors (PPIs) are the mainstay of medical therapy for GERD, but these drugs only provide the control of symptoms and lesions without curing the disease. However, continuous acid suppression with PPIs is recommended for patients with Barrett's esophagus because of their potential chemopreventive effects. In addition to the antisecretory activity, these compounds display several pharmacological properties, often overlooked in clinical practice. PPIs can indeed affect gastric motility, exert a mucosal protective effect, and an antioxidant, anti\u2010inflammatory, and antineoplastic activity, also protecting cancer cells from developing chemo\u2010 or radiotherapeutic resistance. Even in the third millennium, current pharmacologic approaches to address GERD are limited. Reflux inhibitors represent a promise unfulfilled, effective and safe prokinetics are lacking, and antidepressants, despite being effective in selected patients, give rise to adverse events in a large proportion of them. While waiting for new drug classes (like potassium\u2010competitive acid blockers), reassessing old drugs (namely alginate\u2010containing formulations), and paving the new avenue of esophageal mucosal protection are, at the present time, the only reliable alternatives to acid suppression.<\/jats:p>","DOI":"10.1111\/nyas.14447","type":"journal-article","created":{"date-parts":[[2020,8,21]],"date-time":"2020-08-21T13:09:50Z","timestamp":1598015390000},"page":"90-107","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Gastrointestinal pharmacology: practical tips for the esophagologist"],"prefix":"10.1111","volume":"1481","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5645-857X","authenticated-orcid":false,"given":"Carmelo","family":"Scarpignato","sequence":"first","affiliation":[{"name":"Department of Health Sciences United Campus of Malta  Msida Malta"},{"name":"Faculty of Medicine Chinese University of Hong Kong  ShaTin Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua A.","family":"Sloan","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Johns Hopkins School of Medicine  Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David H.","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology UT Southwestern Medical Center and VA North Texas Health Care System  Dallas Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard H.","family":"Hunt","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Department of Medicine, Farncombe Family Digestive Health Research Institute McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,8,21]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gtc.2013.11.001"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2012.444"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2036.2000.00829.x"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.13331"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/ctg.2015.39"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOG.0000000000000543"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1007964"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2017.01.031"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2018.29"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2017.196"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2019.05.056"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2019.07.012"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2015.7193"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2015121377"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2017.06.061"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000014422"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpg.2010.08.011"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(00)70408-2"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.50.1.19"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2036.2002.01325.x"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/307805"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2011-301898"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11894-005-0033-x"},{"key":"e_1_2_8_25_1","first-page":"91","article-title":"Esophageal exposure to acid in GERD patients with and without delayed gastric emptying. 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