Management of severe gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) affects more than one third of the p opulation. It is generally a chronic condition and has the potential to be serious. Some patients with GERD experience persistent daytime or nighttime heartburn and some sustain severe damage, including ulceration, stricture, and Barrett's esophagus, which can predispose to development of adenocarci noma. Extraesophageal manifestations of GERD can include otolaryngologic, r espiratory, and cardiac problems. Severe GERD responds best to agents that suppress gastric acid secretion. Of these, proton pump inhibitors (PPIs) pr ovide the most effective control of gastric acidity and are, therefore, the medical treatment of choice. In fact, nonresponse to a PPI should raise th e suspicion that the diagnosis is not GERD. Proton pump inhibitors are quic kly becoming the treatment of choice for GERD, especially for severe or ref ractory cases. For patients whose GERD is refractory even to PPIs or who ar e unwilling to face years of PPI therapy, antireflux surgery remains an opt ion.