LONG-TERM MANAGEMENT OF GASTROESOPHAGEAL REFLUX DISEASE

Gastroesophageal reflux disease is a common disorder for which a range of treatment options is now available. Most information relates to sh ort-term treatment, but in many respects it is questions concerning lo ng-term management that cause physicians and patients most difficulty. Review of older evidence and some more modern studies shows that refl ux disease is not invariably a chronic, unremitting condition and that in a significant number of patients, acceptable long-term management requires only intermittent symptomatic therapy or no medication at all . For those patients requiring continuous maintenance medication, curr ent evidence implies that proton pump inhibitors, prokinetic agents su ch as cisapride and surgical treatment are the main options to be cons idered. The selection of therapeutic strategies for long-term manageme nt of reflux disease should involve consideration of patient preferenc es and opinions. In many cases this reveals the acceptability of a p.r .n. approach to symptom control, where medication is given only when r equired. Clinical trials and proposed management algorithms which pres ume complete symptom abolition and complete resolution of esophagitis to be the desirable therapeutic goals need to justify these assumption s in the face of evidence which seems to suggest that patients may thi nk differently.