Current approaches in the medical treatment of oesophageal reflux

Gastro-oesophageal reflux and its complications are a common clinical management problem. Medical treatment revolves around the use of physical and mechanical methods in prevent reflux, dieting and drug restriction, acid reduction, mechanical foam barriers, and drugs to increase lower oesophageal sphincter (LES) pressure and improve acid clearance. It is recommended that patients elevate the head of their bed at night, eliminate alcohol and smoking, and avoid food known to decrease LES pressure or irritate the oesophageal mucosa. Antacids are effective in the control of reflux symptoms in most patients with mild to moderate reflux oesophagitis. 'Gaviscon' is also effective but no better than antacids. The histamine H2 receptor blocker, cimetidine, alleviates symptoms and may also improve endoscopic and histological oesophagitis. Cimetidine and drugs which augment sphincter pressure (bethanechol, metoclopramide, domperidone and prostaglandins) may be helpful in treating patients with severe reflux oesophagitis.