GASTROESOPHAGEAL REFLUX .2. MAJOR MEDICALTREATMENTS - EFFICACY AND RISKS

Reference data for the therapeutic management of gastroesophageal refl ux (GOR): The natural history of the disease; the short-and long-term efficiency of the various therapies and their potential risks; patient -related factors (age, associated disorders, personal preference, dura tion and severity of his reflux disease). First line therapy will be m edical in all cases. Potential candidates for surgery: Only patients w ith proven GOR, with or without esophagitis but who have required prot on-pump inhibitors (PPI) are potential candidates for surgery; if thei r esophagitis is not healed after a 8-week PPI regimen, especially, if they remain symptomatic; if they relapse shortly after treatment with drawal and require either frequent intermittent courses or long-term c ontinuous treatment with PPI; moreover if they relapse while continuou sly taking PPI at usual dosage. Long-term treatment with PPI: It looks safe. However there still is some concern about the complete safety o f extremely prolonged treatments started in young patients. (C) 1997, Masson, Paris.