LONG-TERM THERAPY FOR GASTROESOPHAGEAL REFLUX DISEASE - WHO AND WITH WHAT

In general, gastroesophageal reflux disease (GERD) is a chronic relaps ing condition. Some patients can effectively reverse or at least contr ol the disease long term by instituting specific lifestyle modificatio ns and/or by using over-the-counter antacid or alginate preparations. In patients with severe forms of the disease more intensive long term therapy is-usually required; however, it is sometimes difficult to pre dict which patients will require long term maintenance therapy. Three classes of drug - H-2 receptors antagonists, prokinetic agents and pro ton pump inhibitors - have been evaluated in the long term treatment o f GERD. Of these, the proton pump inhibitor omeprazole is undoubtedly the most efficacious, but most gastroenterologists would confine its u se to patients with more severe forms of the disease, whose symptoms c annot be maintained in remission on H-2 receptor antagonists or prokin etics. In selected patients antireflux surgery should be considered as a means of controlling the disease long term, providing one recognize s that surgical expertise in this area is not universal.