Long-term management of gastroesophageal reflux disease and its complications

Although gastroesophageal reflux disease (GERD) is believed to be primarily a motor disorder, current medical therapy is based on the inhibition of acid secretion, since it is the deleterious effects of the acidic refluxate that lead to the symptoms and complications of GERD. Goals of long-term management include the relief of symptoms, healing of esophagitis and prevention of its relapse, and prevention of complications with safe, cost-effective therapy. Maintenance therapy depends on disease severity. Prokinetic drugs have a limited role except in symptomatic nonerosive GERD. Likewise, H2-receptor antagonists are useful in relapsing, nonerosive GERD or in cases of mild initial esophagitis. For severe reflux esophagitis, even high doses of H2-receptor antagonists do not appear to be as effective as proton pump inhibitors. GERD patients with severe reflux esophagitis or complications such as peptic stricture or Barrett's esophagus should be maintained on proton pump inhibitors such as lansoprazole or omeprazole. For young and otherwise healthy patients, antireflux surgery is a viable option.