[Reflux disease: drug treatment]

Reflux disease of the esophagus is characterized by a high prevalence and by high relapse rates. Upper endoscopy is the key procedure for diagnosis of the disease as well as for follow up, since treatment is determined by disease intensity as judged by endoscopy. High activity of disease is associated with an increased risk of complications, in the worst case development of adenocarcinoma. General recommandations (weight reduction, change of eating habits) constitute the start of each treatment regimen, and may add to improvement of symptoms, sometimes in combination with antacids. Prokinetics and H2-receptor antagonists are effective in mild reflux disease (grade O, I), but even in these situations proton pump inhibitors (PPI) exhibit better relief of symptoms and more rapid healing. PPI are the drugs of first choice for higher disease activity, often in larger than standard daily doses. The treatment period for acute disease may be as long as 12 weeks. Long term prophylaxis is only effective with PPIs, mostly in the standard daily dose. Duration of long term treatment is determined by disease activity and tendency of the lesions to heal. Today, in case of treatment failure and of high grade lesions antireflux surgery is increasingly being reconsidered, particularly since minimally invasive methods are available.