[Long-term drug therapy versus antireflux surgery in chronic reflux]

In endoscopy-negative reflux disease just 25% remain in remission after drug therapy, in reflux oesophagitis only 10%. Long-term management is therefore mandatory in this quality of life-impairing chronic disorder. Following the GENVAL consensus conference proton pump inhibitors (PPI) should be used primarily in a step-down regimen; isomeric PPIs reduce duration of acute therapy by 50%. According to Klinkenberg-Knol et al. 100% of all patients with H2-resistant reflux oesophagitis are asymptomatic and free of recurrency when dosage of PPI is adapted to a higher level. The same result was obtained in the prospective study by Lundell et al. comparing fundoplication and long-term management with omeprazole for 3 years.