CONTEMPORARY MEDICAL THERAPY FOR GASTROESOPHAGEAL REFLUX DISEASE

Gastroesophageal reflux disease is a chronic disorder that requires lo ng-term therapy in most patients. The appropriate medical therapy shou ld be individualized to the severity of symptoms, the degree of esopha gitis and the presence of other acid-reflux complications. Lifestyle c hanges should form the basis of any therapeutic approach. in patients with mild to moderate disease, initial therapy with histamine H-2-rece ptor antagonists in conventional dosages is suggested. Prokinetic agen ts are potentially useful in patients with impaired esophageal or gast ric motor function, but their efficacy as single agents does not appea r to surpass that of standard doses of H-2 blockers. Sucralfate, a cyt oprotective agent, is an, additional therapeutic option. For patients with more severe disease, omeprazole and lansoprazole provide unequale d healing rates and accelerated symptom relief. In most patients, main tenance therapy is vital. Surgery is indicated in patients whose disea se is refractory to medical therapy and in those who develop complicat ions not amenable to medical therapy.