Pharmacologic modulation of motility

Etiologically, gastroesophageal reflux disease (GERD) can be regarded as mo tility disorder Although blocking acid is effective in the treatment of GER D, it does not overcome the underlying pathologic factors that allow acid, pepcin, and bile to reflux into the esophagus. Prokinetic agents address th e upper gastrointestinal motility disturbances contributing to GERD and, th us, have an important role in the short- and long-term medical management o f reflux esophagitis. This paper discusses the rationale for the effectiven ess of pharmacologic modulation by reviewing current concepts and postulate d theories about the mechanisms underlying the neuromuscular abnormalities. The multifactorial aspects of GERD are addressed and the potential for tai loring medical therapy also emphasized.