Management of patients with symptomatic gastroesophageal reflux disease: Aprimary care perspective

The availability of antacids and over the counter (OTC) histamine 2 (H2) re ceptor antagonists provide ample opportunity for individuals with symptomat ic reflux to self-medicate before or instead of visiting a physician. Becau se many patients will not achieve complete relief from OTC products, clinic ians will be required to rethink treatment strategies for those who present with persistent reflux symptoms after a trial of low dose H2 receptor anta gonists or other antisecretories. Patients with persistent heartburn or reg urgitation without evidence of "alarm symptoms" will usually not require a diagnostic study of the upper GI tract. Counseling on lifestyle modificatio ns and empirical antisecretory therapy is indicated in most situations. Pro ton pump inhibitors have consistently demonstrated superior symptom relief when compared to H2 antagonists for patients with erosive esophagitis and f or patients with nonerosive disease. If proton pump inhibitors consistently reduce the need for physician visits and diagnostic testing, they would se em to be a logical first choice pharmaceutical for individuals who fail to improve with OTC H2 antagonists. (C) 2001 by Am. Coll. of Gastroenterology.