Drug therapy of reflux oesophagitis: an update

The various therapeutic approaches for reflux oesophagitis are to enhance oesophageal clearance, to coat damaged tissue, to increase the competence of the reflux barrier, to reduce the volume and pH of gastric contents, and to improve gastric emptying and pyloric sphincter competence. Unfortunately, drug therapy of reflux oesophagitis is not yet ideal. Of the prokinetic agents, cisapride is the only drug with proven benefit. Single-agent therapy with the H2-receptor antagonists or sucralfate results in similar degrees of symptom relief and healing. Rapid symptom relief and healing are achieved by omeprazole; however, the significance of sustained achlorhydria remains to be established. Dinnertime dosing of cimetidine appears to be a rational method of suppressing late-evening gastric acidity. Patients with severe or recalcitrant disease should not be treated with conventional therapy alone; the results of controlled studies of combination therapy with the H2-receptor antagonists and sucralfate or cisapride will be viewed with interest.