[Treatment of gastroesophageal reflux]

Several therapeutic means are available for the treatment of pathological gastroesophageal reflux (GOR): positional therapy, thickening the feedings, dietetic modifications, antacids, mucosa-protecting agents, gastrokinetic drugs, antisecretory drugs, and surgery. In uncomplicated GOR, simple measures must be used first, associating positional therapy, thickening the feedings and a mucosa-protecting agent or an antacid; a gastrokinetic drug will be added if these measures are insufficient after 2 or 3 weeks. Peptic esophagitis requires a more drastic treatment, using antacid, prekinetic and antisecretory drugs; in addition, its cure should be assessed by esophagoscopy. When GOR is associated with life-threatening events, treatment may be completed with an atropine derivative in case of vagal hypertonia, and its efficiency must be verified by monitoring of oesophageal pH under treatment. In infants, the medical treatment should be maintained until complete cure, which usually occurs when walking is achieved. Surgery is indicated in complicated GOR (esophagitis, life-threatening event, pulmonary complication) with failure of the medical treatment, or as first-line treatment in the case of severe esophagitis in children with severe psychomotor impairment.