[Therapeutic strategy in the treatment of gastroesophageal reflux]

Management of gastro-oesophageal reflux disease depends on the importance attached by the physician to symptoms and to risk of complications, ie: stricture, haemorrhage, operation- and drug-hazards. A patient who suffers rarely and during short periods could require dietary and postural recommendations and the use of the following drugs: antacids, alginates, prokinetic agents and/or H2-receptor antagonists. We consider that the rarity of stricture rules out the necessity of any change in management, whether or not erosive oesophagitis is observed at endoscopy. Most patients are treated with these drugs. On the other hand, when symptoms are frequent and occur daily and especially at night and when H2-receptor antagonists fail to relieve the pain, a more potent drug such as omeprazole is to be administered. The same applies to patients running the risk of haemorrhage resulting from anticoagulant coexisting therapy, the later condition requiring the lesions to be healed and relapse prevented. In the long run, the choice between a drug (H2-receptor antagonist or omeprazole) taken daily and surgery can be debated. Even when a stricture is present surgery is no longer necessary due to failure of conservative management. The decision depends on the operation-linked risks relative to the patient's condition and on his or her compliance to daily drug-administration. Respiratory or ENT complications are often difficult to alleviate by H2-receptor antagonists and may need to be treated with omeprazole.