[Therapy of gastroesophageal reflux disease]

The natural history of gastroesophageal reflux disease is usually that of a chronic disorder. Spontaneous remission is rare, and cure even more so, especially in more severe cases. Treatment of esophagitis has been eased in most cases with current drugs, but recurrence is almost the rule after discontinuation of therapy. Therefore, long-term treatment is required in many patients. The drugs of preference for long-term treatment are acid inhibitors given at the lowest dose that suppresses symptoms. Surgical treatment should be reserved for the rare patient who cannot be managed satisfactorily with conservative treatment. Because of the high risk of adenocarcinoma in Barret's esophagus, endoscopic surveillance of all patients with acceptable surgical risk is recommended.