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[Reflux disease: drug treatment]
1Städtisches Klinikum, I. Medizinische Klinik, Karlsruhe.
Praxis
|October 28, 1998
Summary
Proton pump inhibitors (PPIs) are the most effective treatment for reflux esophagitis, offering better symptom relief and healing than other medications. Long-term PPIs are crucial for preventing relapse and managing severe disease.
Area of Science:
- Gastroenterology
- Internal Medicine
Context:
- Reflux esophagitis presents with high prevalence and relapse rates.
- Upper endoscopy is crucial for diagnosis and monitoring disease intensity.
- High disease activity correlates with increased risk of adenocarcinoma.
Purpose:
- To review current treatment strategies for reflux esophagitis.
- To highlight the efficacy of proton pump inhibitors (PPIs) across different disease severities.
- To discuss the role of surgery in refractory cases.
Summary:
- Lifestyle modifications and antacids are initial steps.
- Prokinetics and H2-receptor antagonists are useful for mild disease (grades O, I).
- PPIs demonstrate superior efficacy for symptom relief and healing, even in mild cases, and are first-line for severe reflux esophagitis, often requiring higher doses and up to 12 weeks of acute treatment.
- Long-term PPI prophylaxis is effective for preventing relapse.
- Antireflux surgery is an option for treatment failures and high-grade lesions, especially with minimally invasive approaches.
Impact:
- Establishes PPIs as the primary pharmacotherapy for reflux esophagitis.
- Informs clinical decision-making regarding treatment duration and dosage.
- Supports the consideration of minimally invasive surgery for complex cases.