[Acid reflux on the esophagus. What helps in acute reflux esophagitis, how to prevent a recurrence?]

Gastro-esophageal reflux disease--one of the most common diagnoses in gastroenterology--is characterized by its symptoms or mucosal lesions caused by the non-physiological exposure of the esophagus to gastric juice. For its acute treatment, proton pump inhibitors are distinctly superior to histamine 2 receptor antagonists, and are the treatment of choice. Since relapse is common, long-term treatment is often necessary. Although PPI are the most effective substances over the long-term too, cisapride and/or histamine receptor antagonists may suffice to prevent relapse. In severe and complicated cases, however, the long-term use of proton pump inhibitors is mandatory. While, in such cases, laparoscopic antireflux surgery offers an alternative, neither long-term data nor controlled studies comparing this approach with long-term medical treatment have been carried out. A major complication of reflux disease is Barrett's metaplasia with its associated risk for adenocarcinoma development. Barrett's epithelium can be eradicated by endoscopic thermal ablation combined with acid suppression. However, as endoscopic therapy bears risks and data on long-term efficacy are still lacking, the significance of thermal ablation has further to be evaluated in specialized centers.