[Medical treatment of reflux peptic esophagitis: literature review]

Treatment of GO reflux and reflux oesophagitis should be based on pathophysiology, natural history, diagnostic assessment and patient expectations. Physiopathologically, GO reflux results from the balance between aggression and defence. The primary importance of motor and sphincters disturbances should make prokinetic drugs the treatment of choice; however, these drugs are unable to influence the inappropriate sphincter relaxation. The severity of symptoms and lesions is related to the duration of exposition of the oesophagus to pH < 4 explaining the superiority of omeprazole over the usual doses of H2RA. Since symptoms and lesions relapse frequently after treatment, long term prophylaxis, either by surgery or by drugs, is necessary. Comparing different therapeutic options is complicated by the absence of a precise definition of abnormal GO reflux or a gold standard; moreover, treatment results depend on the initial oesophagitis grade. Treatment will depend on the desired goal: to treat symptoms of lower grade oesophagitis or to heal lesions and prevent complications of high grade oesophagitis.