Pharmacologic strategies for treating gastroesophageal reflux disease

Objective: This paper presents a synopsis of the pathophysiology of gastroe sophageal reflux disease (GERD) and the efficacy, safety, and cost of the a gents commonly used in its treatment. Background: Symptomatic relief of GERD can be obtained with lifestyle chang es (avoidance of factors that may exacerbate symptoms, such as overeating a nd use of alcohol and tobacco) and use of over-the-counter medications such as antacids or histamine-2 (H-2)-receptor antagonists. When these measures are unsuccessful, treatment with prescription-strength medications is requ ired to prevent complications, such as Barrett's esophagus or esophageal ad enocarcinoma. Methods: Current guidelines for the management of GERD were identified thro ugh a MEDLINE(R) search of the English-language literature from January 199 5 through December 1999 and a search of the bibliographies of identified ar ticles. Conclusion: Patients who do not respond to initial therapy should be manage d with prescription-strength H-2-receptor antagonists. Endoscopy should be considered for patients with atypical or refractory symptoms, patients with a confirmed diagnosis of refractory GERD, severe esophagitis, Barrett's es ophagus, or peptic stricture should be treated with and maintained on a pro ton-pump inhibitor.