SEVERE GASTROESOPHAGEAL REFLUX DISEASE - MEDICAL AND SURGICAL OPTIONSFOR LONG-TERM-CARE

Severe gastroesophageal reflux disease is usually a chronic problem wi th periods of relapse, but effective medical and surgical therapies ar e available. Two recently introduced agents, omeprazole Prilosec) and cisapride (Propulsid), represent advances in medical therapy; the safe ty of long-term, continuous omeprazole therapy is under investigation. Used by surgeons with sufficient experience, the new laparoscopic app roach offers potential advantages over conventional antireflux surgery in suitable candidates. The decision of whether to recommend long-ter m medical therapy or surgery must be individualized. Medical therapy m ay be the best choice in elderly patients and poor surgical candidates , in patients whose symptoms are well controlled with omeprazole and w ho accept its benefit-risk profile, and when a highly experienced anti -reflux surgeon is not available. Surgery may be appropriate (assuming a skilled surgeon is available) in patients who are young, have troub le taking medication, need multiple agents to control symptoms, and ne ed continuous omeprazole therapy but are unwilling to accept the theor etical risk of gastric carcinoid tumors that accompanies it.