[Internal medicine therapy in reflux disease]

Gastro-oesophageal reflux disease is a very common disorder. Treatment intends to relieve symptoms, prevent complications and recurrence of the disease. The initial approach in a patient with heartburn alone is to begin a therapeutic trial with antacids sucralfate, a prokinetic agent, a histamine-receptor antagonist or a low dose of a proton pump inhibitor. If the therapeutic trial fails, dysphagia or atypical symptoms are present, therapy depends on diagnostic findings. In mild and moderate disease, acute treatment consists of 20 to 40 mg of a proton pump inhibitor (omeprazole, lansoprazole or pantoprazole) and maintenance treatment of low dose omeprazole (10 mg). In severe disease a higher dose is administered, 40 to 80 mg of omeprazole, lansoprazole or pantoprazole for acute treatment and 20 mg of omeprazole for maintenance treatment. Maintenance treatment is adjusted to symptoms and in the case of severe disease also to endoscopic findings.