{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:22:52Z","timestamp":1788222172105,"version":"build-2803163510"},"reference-count":203,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T00:00:00Z","timestamp":1749600000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T00:00:00Z","timestamp":1749600000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therap Adv Gastroenterol"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:p>\n                    Gastroesophageal reflux disease (GERD) remains a challenging condition, even in the third millennium. For much of the past century, Schwartz\u2019s dictum\u2014\u201cNo acid, no ulcer\u201d\u2014has 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\u2019s 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\u2122 One, Esoxx Defence, and Esoxx Protection), incorporating additional components, that is, Poloxamer 407, aluminum hydroxide, or natural remedies such as\n                    <jats:italic toggle=\"yes\">Aloe vera<\/jats:italic>\n                    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\u2019 overall quality of life.\n                  <\/jats:p>","DOI":"10.1177\/17562848251337822","type":"journal-article","created":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T09:46:52Z","timestamp":1749635212000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Hyaluronic acid and chondroitin sulfate-based medical devices: formulations, esophageal mucosal protection, and their place in the management of GERD"],"prefix":"10.1177","volume":"18","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, MSD 9024, Msida 9024, Malta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1995-1060","authenticated-orcid":false,"given":"Nicola","family":"De Bortoli","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Iovino","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Salerno, Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Nacci","sequence":"additional","affiliation":[{"name":"ENT Audiology and Phoniatric Unit, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Sarnelli","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine and Surgery, \u201cFederico II\u201d University of Naples, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3187-2894","authenticated-orcid":false,"given":"Edoardo Vincenzo","family":"Savarino","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,6,11]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2016-313589"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrgastro.2018.32"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-90525-9_23"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1080\/17512433.2020.1752664"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14022"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13752"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms24032502"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.14473"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1080\/14656566.2024.2416585"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/apt.16930"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2011-301898"},{"key":"e_1_3_4_13_2","article-title":"Does the evidence show that prokinetic agents are effective in healing esophagitis and improving symptoms of GERD?","volume":"1","author":"Looijer-van Langen M","year":"2007","unstructured":"Looijer-van Langen M, Veldhuyzen van Zanten S. 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