Optimizing symptom relief and preventing complications in adults with gastro-oesophageal reflux disease

Gastro-oesophageal reflux disease (GORD) is a chronic illness causing recurrent typical and atypical symptoms. Possible complications include oesophagitis, ulcer, stricture and Barrett's oesophagus. Evidence suggests that the intraoesophageal pH correlates directly with the degree of mucosal injury. Proton pump inhibitors (PPIs) are the first choice of therapy because they are significantly more effective than histamine-2-receptor antagonists (H(2)RAs) in achieving and sustaining an intragastric pH above 4.0. Numerous trials have shown that PPIs provide superior and faster relief of heartburn compared with H(2)RAs. PPIs have also been shown to be superior to H(2)RAs in healing oesophageal ulcers and improving the clinical outcome of patients with stricture formation. Unfortunately, even higher-than-standard doses of PPIs do not provide a complete regression in the length of Barrett's oesophagus, which is the most serious complication of GORD. Although the majority of patients with oesophagitis relapse within 6 months of stopping PPI therapy, maintenance PPI therapy prevents this in more than 80% of cases. Surgical and endoscopic procedures are alternative approaches to managing GORD. Surgery is successful but is not without risk. Endoscopic procedures are promising, but comparative and longer-term efficacy and safety data are needed.