Medical therapy for gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a chronic condition that ranges f rom mild, intermittent symptoms to more severe cases of esophageal strictur es and possibly adenocarcinoma of the esophagus, The etiology of GERD is mu ltifactorial, although transient lower esophageal sphincter relaxations are thought to play an important role in addition to poor esophageal clearance and weak lower esophageal sphincter pressures. Lifestyle modifications and over-the counter medications may be used to treat GERD, After these method s are tried, therapy with histamine receptor type 2 antagonists is the best treatment, although increasingly, proton pump inhibitors are being used. L ong-term therapy needs to be maintained in patients with GERD, in contrast to those patients with peptic ulcer disease. The role of lifestyle modifica tions is described, and the costs of the various regimens are compared.